Small intestine cancer, or simply, intestinal cancer, happens when the cells present in the lining of the small intestine start dividing abnormally.
The small intestine is divided into three parts, which are duodenum (the portion that connects the stomach with the small intestine), jejunum (middle portion of the small intestine) and ileum (the portion that connects the small intestine to the colon). This cancer type commonly arises from the duodenum.
It is one of the rare cancers in India. Major risk factors for this condition include poor diet habits, presence of polyps, history of bowel disorders, etc.
Based on the type of the cells that they originate from, small intestine cancers are categorised into the following types:
The symptoms of small intestine cancer are often confused with that of less severe health conditions. This leads to delayed diagnosis, wherein the condition is diagnosed months after it develops and starts showing symptoms.
Pain and discomfort are the primary symptoms associated with small intestine cancer. Other key symptoms associated with small intestine cancer include:
The exact cause of small intestine cancer is not known. However, a few factors that can increase the risk of small intestine cancer are identified, and they are listed below:
In many cases, the diagnosis of small intestine cancer is delayed due to vague and non-specific symptoms. This leads to various complications and calls for the need for a comprehensive treatment plan. Delayed diagnosis also has a negative impact on clinical outcomes and survival rates. Therefore, one must avoid ignoring symptoms and consult a doctor for an accurate diagnosis. Following are the key procedures employed in the detection and diagnosis of small intestine cancer:
a. Physical Exam and Medical History Assessment: In the beginning, the doctor physically examines the patient for the signs of small intestine cancer, such as the presence of lumps or any other anomalies. The doctor may also take notes of the symptoms experienced by the patient, underlying medical conditions, previously-received treatments, allergies, etc.
b. Blood Tests: In small intestine cancer patients, the tumour starts bleeding over time, and this leads to anaemia. A simple blood test may be recommended to check if all different types of blood cells are present in optimum quantities. Blood tests may also be recommended to assess liver and kidney functions. This test is also helpful in checking if cancer has spread to other organs in the body.
c. Faecal Occult Blood Test: This test helps in detecting small amounts of blood that cannot be seen through naked eyes. The presence of blood in stools is an indication of polyps, bowel inflammation, small intestine cancer or colorectal cancer. In the case of a positive faecal occult blood test, additional tests may be recommended in order to arrive at a definitive diagnosis.
d. Endoscopy: Endoscopy is a diagnostic procedure that is recommended for the diagnosis of most gastrointestinal cancers. A slender tube that is fitted with a light source and video camera is inserted into the GI tract, and this allows the technicians to thoroughly check the regions of the bowel for the presence of polyps and other abnormalities. There are different types of endoscopy available for the diagnosis of small intestine cancer:
e. Barium X-ray: At times, the doctor may recommend Barium X-ray for a small intestine cancer diagnosis. During this procedure, the patient is made to drink a small quantity of liquid barium, which, upon swallowing, coats the lining of the esophagus, stomach and small intestine. Later, an X-ray scan is performed.
The X-rays are absorbed by barium, and the barium-coated regions appear white on the X-ray film. This helps the doctor in thoroughly studying the lining of the small intestine and find if there are any abnormalities, such as inflammation, polyps or tumour.
f. Imaging Tests: Various imaging tests, namely MRI scan, PET CT scan, etc., may be recommended to obtain detailed information on the size, shape and exact location of the tumour. Additionally, the results from these imaging tests help doctors in disease staging, treatment planning, therapy monitoring and restaging.
g. Biopsy: Biopsy is recommended for the definitive diagnosis of small intestine cancer. During this procedure, a small amount of tissue is collected from the suspected area, and it is later examined under a microscope for the presence of abnormal cells. The biopsy sample may be either collected during the endoscopy or surgery.
There are multiple treatment approaches available for small intestine cancer. While devising the treatment plan, the doctor considers multiple parameters, such as the stage of the disease, exact location of the tumour, its size, age of the patient, his/her overall health condition and preferences.
Primarily recommended treatment options for small intestine cancer include surgery, radiation therapy and chemotherapy. Those small intestine cancers that do not respond to the conventional treatments may be treated with immunotherapy and targeted therapy.
a. Surgery: Surgery is the main line of treatment for small intestine cancer. Depending on the stage and other factors, the doctor may recommend one of the surgical procedures:
Robot-assisted surgery is another minimally-invasive approach, wherein the arms of the robotic surgery system imitate the hand movements of the surgeon, only with enhanced precision. Robotic surgeries are performed through tiny incisions as well. Minimally invasive surgeries have multiple advantages, such as shorter hospital stays, reduced blood loss and pain, minimal scarring and faster recovery.
For larger tumours or for tumours that are close to the critical organs like the pancreas and liver, open surgeries are largely preferred. For a better understanding of their treatment plan, the patients and their caregivers must talk to their doctors.
b. Chemotherapy: Chemotherapy is often a part of the treatment plans made for small intestine cancer. This treatment approach involves the administration of strong anticancer drugs into the body to destroy the cancer cells, slow their growth and relieve the symptoms caused by the disease.
Chemotherapy may be administered before the surgery in order to shrink the tumour (neoadjuvant chemotherapy); it may also be administered after the surgery to destroy the residual cancer cells and bring down the risk of cancer recurrence (adjuvant chemotherapy).
Chemotherapy is also given as a part of palliative therapy wherein the patient has advanced small intestine cancer, which is difficult to treat, and the patient needs support in managing the symptoms, such as pain and discomfort, caused by the disease.
c. Radiation therapy: Radiation therapy is also recommended for small intestine cancer management. It involves the usage of powerful radiation beams to kill cancer cells. Radiation therapy may also be used to alleviate the symptoms caused by the disease. In a few cases, radiation therapy is combined with chemotherapy in order to enhance the efficacy of the treatment administered.
d. Immunotherapy: For small intestine cancers that do not respond to the conventional treatment approaches, immunotherapy may be recommended. Immunotherapy involves stimulating the patient’s own immune system to launch an attack against cancer cells. Immunotherapy works by strengthening, directing or restoring the body’s natural defences against cancer.
e. Targeted Therapy: Targeted therapy is another unique treatment approach that is recommended for small intestine cancers – only in cases where the patient is showing no response to main treatments. It is also known as precision therapy because it attacks cancer cells only. Targeted therapy works by identifying particular vulnerabilities present on the cancer cells and blocking their growth via multiple complex mechanisms.
Yes, small intestine cancer is treatable. Small intestine cancer management is more feasible lately as we have multiple treatment options available today.
Studies have found that early detection positively impacts the quality of clinical outcomes and survival rates. If small intestine cancer is detected in its early stage, surgery alone is sufficient to treat it successfully in a few cases.
In order to catch small intestine cancers in the early stages, one should be mindful of the symptoms. Any pain, swelling or discomfort associated with the abdominal region should not be ignored and brought to the attention of a doctor immediately.
Yes, in a few cases, small intestine cancers can recur. However, they can still be treated with positive outcomes if they are caught early.
In order to prevent relapses or catch them early, it is important for patients to keep up their follow-up appointments that will be scheduled after the treatment.
Yes, small intestine cancer can spread to other organs if it is not treated on time. In the beginning, it will spread to the nearby lymph nodes, and as the disease progresses, it starts spreading to nearby organs like the liver, lungs, etc.
Early diagnosis and timely treatment play a significant role in reducing the risk of cancer metastasis.
There are no known ways to prevent small intestine cancer completely. Nevertheless, there are a few measures that you can follow to reduce your small intestine cancer risk: