Small Intestine Cancer

You should consult a doctor if you experience any of the following problems:

• Pain or cramps in the middle of the abdomen
• Weight loss with no known reason
• A lump in the abdomen
• Blood in the stool

These and other symptoms may be caused by cancer or by other conditions, so it's important to talk to a doctor who can help determine the cause.

Your diet and health history can increase your risk of developing small intestine cancer.

A risk factor is something that increases your chances of developing a disease. Risk factors for small bowel cancer include:

• Eating a high-fat diet

• Having Crohn’s disease

• Having celiac disease

• Having familial adenomatous polyposis (FAP)

Talk to your doctor if you have two or more risk factors, as you may be considered to have a high risk of disease. You may benefit from our Gastrointestinal Cancer Prevention program, where a multidisciplinary team of specialists will help you understand and manage your risk of this disease and other related cancers.

Because there's no definitive cause of this type of cancer, there's no way to guarantee prevention. However, there are several things you can do to optimize your health and lower your risk of cancer, including:

• Avoiding tobacco
• Limiting alcohol
• Eating a nutritious diet
• Maintaining a healthy weight

If you have symptoms, you may benefit from a screening test.

Unlike screenings for colon cancer and other types of cancer, there is no standard screening test for small intestine cancer. Therefore, if you don't have any symptoms of the disease and you aren't considered to have a high-risk, screening is not recommended. However, if you have signs of the disease, such as abdominal pain or sudden weight loss, there are several tests that may help detect this type of cancer. And, if you are considered to have a high-risk of developing a GI cancer, your doctor may recommend a screening test to increase your chances of early detection.

If you have symptoms of this type of cancer, a gastroenterologist will conduct a physical exam and ask you about your medical history. Then, they may recommend one or several tests, including imaging that may help for diagnosis. If these tests confirm cancer, your doctor will also stage the cancer or determine how far it has spread at the same time. This information is important because it will help inform your treatment options, including whether or not the tumor can be removed with surgery.

The following tests and procedures may be used:

• Blood tests, including:

  • Liver function tests: Your doctor may analyze a blood sample for certain substances released into the blood by your liver. If the amount of these substances is higher than usual, it may be a sign of disease caused by this cancer.

  • Fecal occult blood test: A test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.

• Imaging tests, including:

  • Abdominal X-ray, computed tomography (CT scan or CAT scan), or MRI

  • Endoscopy, which uses an endoscope (a thin, lighted tube) to look at the inside of the esophagus, stomach, and small intestine. There are several types of endoscopy, including:

    • Upper endoscopy to view the first part of the small intestine (called the duodenum)

    • Capsule endoscopy, which involves swallowing a capsule with a tiny camera that travels through the digestive tract

    • Double balloon endoscopy, which uses an endoscope placed inside an outer tube and attached to a balloon to move through and view the entire small intestine

  • Upper GI series with small bowel follow-through, which involves drinking a liquid containing barium before taking a series of X-rays of the upper gastrointestinal (GI) tract

• Biopsies, which removes cells to be analyzed for signs of cancer by a pathologist. Tissue samples may be performed during an upper endoscopy, a lymph node biopsy, or laparotomy.

• Laparotomy, which allows surgeons to check for disease inside the abdomen using an incision

While staging is important, these tumors are grouped based on the type of small intestine cancer and whether the tumor can be removed by surgery.

The types of cancer found in the small intestine are:

• Adenocarcinoma, the most common type of this cancer that begins in the glands of the small intestine lining

• Carcinoid tumors, which begin in neuroendocrine cells located in the small intestine

• Sarcoma, which is referred to as leiomyosarcoma when found in the smooth muscle cells of the small intestine

• Gastrointestinal stromal tumor, which begins in the interstitial cells of Cajal in the intestine

• Lymphoma, which begins in the lymph nodes

Knowing the type of cancer you have is important because they each require different treatment.

In order to plan treatment, it is important to know the types and whether your tumor can be removed by surgery. At MedStar Health, your care team involves specialists across several disciplines, including gastroenterology, surgical, medical, and radiation oncology, pathology, and others. These doctors work together to evaluate your cancer and determine a treatment approach that will be safe and effective for your unique case.

Your treatment options may vary depending on:

• The type of small bowel cancer you have
• Whether cancer has spread to other places in the body
• Whether cancer can be completely removed by surgery
• Whether cancer is newly diagnosed or has returned

Surgery

Surgery is the most common treatment of small intestine adenocarcinomas and leiomyosarcomas. Depending on your tumor, your surgeon may perform one of the following types of surgery:

• Intestinal resection: This type of surgery involves removing part or all of the small intestine. Once your surgeon removes the cancerous part of the intestine, they will perform an anastomosis, which connects the cut ends of the intestine together. If cancer has spread to nearby organs, your surgeon may also remove those through a complex Whipple procedure (pancreatoduodenectomy). They may also remove nearby lymph nodes, which can be examined by a pathologist to see if they contain cancer.

• Bypass: If a tumor is blocking your intestine but cannot be removed, a surgeon may perform a bypass surgery. This procedure will allow food to go around, or bypass, the tumor to allow food to continue through the digestive system. A bypass is typically performed as palliative surgery to relieve symptoms, such as abdominal pain, nausea, and vomiting.

Many times, patients benefit from other treatments in addition to surgery. This recommendation will be determined at a multidisciplinary tumor board, where all of your doctors will meet to discuss your best options.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells. It's a systemic therapy, which means that drugs enter the bloodstream to reach cancer cells throughout the body. Because of its widespread effect, chemotherapy may cause side effects. However, our specialists are experts in helping to manage these. When appropriate, we may adjust your treatment plan to best address your needs.

Your care team will include a medical oncologist who will determine if you may benefit from chemotherapy with or without other therapies. For example, patients with adenocarcinomas may receive chemotherapy with radiation therapy if their tumor cannot be removed. In other cases where the tumor cannot be removed, chemotherapy may help to relieve symptoms and improve your quality of life.

Immunotherapy and targeted therapy

Through clinical trials, we're learning new ways to treat adenocarcinomas and leiomyosarcomas using drugs that use your immune system to slow cancer growth. Called immunotherapy or biologic therapies, these treatments can prolong your survival and may have fewer side effects than chemotherapy. Other types of small intestine cancers, including GISTS, may benefit from targeted therapies using drugs that pinpoint tumors with certain proteins and genes. If your tumor cannot be removed, your medical oncologist may recommend a clinical trial that offers access to these newer drugs before they're widely available.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells. If the tumor in your small intestine cannot be removed, your radiation oncologist may recommend external radiation therapy to:

• Shrink the tumor (with or without chemotherapy)
• Relieve symptoms and improve your quality of life

We use several types of radiation therapy, including the latest advances that improve precision and spare healthy tissue. Some patients also benefit from radiosensitizers, which are drugs that increase cancer cells' sensitivity to radiation therapy. Your care team will discuss the pros and cons of the types of radiotherapies that may best treat your cancer.