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A rare condition in which cancerous tumors develop in the small bowel. The most common types include adenocarcinoma, lymphoma, sarcoma, and carcinoids. All of these tumors have the potential to invade the bowel wall, spread into adjoining lymph nodes, and metastasize.
Incidence; Risk Factors
In developed nations, adenocarcinomas are most common whereas in developing countries, lymphomas are much more common. At the start of the 21st century, doctors in the US were diagnosing only about 1,200 malignant small intestine tumors each year - a very small number compared to the frequency of tumors in other parts of the GI tract.
Put another way, cancer is 50 times more common in your large bowel than in your small bowel. This may be due to several factors, such as the liquid nature of the contents of the small intestine (less irritation), the rapid transit time (less exposure time to toxic agents), the low bacteria count, or the alkaline pH.
Risk factors include the following:- Adenocarcinoma of the small bowel is associated with Familial Polyposis Syndrome - an inherited disease in which the large bowel becomes carpeted by polyps of various dimensions during the second or third decade of life. If untreated, the disease invariably leads to cancer of the colon or rectum.
- Alcohol abuse
- Consumption of salted or smoked meats and fish
- Heavy sugar intake
Signs & Symptoms
Like most GI cancers, early symptoms of small bowel cancer tend to be vague and nonspecific. They may include abdominal discomfort associated with nausea, bloating and/or loss of appetite.
Symptoms of advanced disease include fatigue, weight loss, iron deficiency anemia, visible blood loss (vomiting blood or a material that looks like coffee grounds, or black stools), severe nausea and vomiting (because of the blockage caused by the cancer in the small bowel), jaundice (when the cancer involves the upper small intestine and blocks the bile ducts draining the liver).
Diagnosis & Tests
Doctors frequently diagnose small intestine cancer during surgery for unexplained bowel obstruction. If cancer is suspected, doctors usually choose to perform a barium contrast study of the small intestine. Upper GI tract endoscopy may be useful in detecting areas of concern in the immediate upper GI tract, and a CT scan of the abdomen or an abdominal ultrasound may help to visualize bulky tumors and to rule out any spread of the cancer to adjacent lymph nodes and distant organs such as the liver. A colonoscopy may help diagnose tumors involving the lower areas of the small bowel.
Treatment & Prevention
Surgical removal is the primary treatment for cancer of the small intestine. Chemotherapy or radiation therapy may be useful if the cancer is widespread; radiation therapy also may be helpful if there is widespread disease or if local tumors come back. Surgery may relieve symptoms when the cancer has caused a bowel obstruction. In this case, doctors may perform a bypass procedure or limited tumor removal.
Prevention:- The association of small bowel cancer with underlying conditions makes it possible to identify populations at risk and to develop screening programs.
- People with a family history of polyp syndromes, such as Peutz-Jeghers and Gardner syndrome, may benefit from regular screening using upper GI tract barium studies.
- People with celiac disease are at higher risk of developing both adenocarcinoma and lymphoma of the small bowel. They need to maintain a gluten-free diet.
- People with celiac disease who also have new onset weight loss, diarrhea, or abdominal pain need immediate medical attention, including possible CT scan of the abdomen and barium study of the small bowel to rule out cancer.
- People with Crohn disease and small bowel bypass procedures also require immediate attention.
- Crohn disease-related adenocarcinoma frequently develops in the lower end of the small bowel, making colonoscopy a potentially useful screening tool.
Prognosis
Fewer than 35% of people who have adenocarcinoma of the small bowel have a live more than 5 years after diagnosis. Survival chances are better if the cancer is limited to the inner walls of the small intestine and the lymph nodes are not involved. Chances are better still if the patient has a carcinoid tumor or lymphoma of the small bowel - these malignancies tend to respond better to chemotherapy and radiation treatment when doctors cannot completely remove the tumor. The prognosis is poor, however, if there is a small bowel lymphoma alongside celiac disease or a weakened immune system.
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Signs, symptoms & indicators of Small Intestine Cancer:
Risk factors for Small Intestine Cancer: | | | | | Autoimmune |  Crohn's Disease | Adenocarcinoma of the small bowel is associated with Crohn disease, which usually occurs in the lower part of the small intestine (the ileum). The inflammation extends deep into the lining of the affected organ, causing pain and making the intestines empty frequently, resulting in diarrhea. For those with Crohn's disease, the risk of developing small intestinal cancer is 6 times greater than for those without it. Additional risk factors for those with Crohn's disease include:- Being male
- Having a long history of Crohn's
- Fistulous disease that is associated with Crohn's
- Surgical removal of part of the bowel.
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Gluten Sensitivity / Celiac Disease |
Immunity |
Weakened Immune System |
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Small Intestine Cancer suggests the following may be present:
Recommendations and treatments for Small Intestine Cancer:
KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Weakly counter-indicative |  | | Likely to help |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
AIDS
Acquired Immune Deficiency Syndrome. An immune system deficiency disorder that suddenly alters the body's ability to defend itself. The AIDS virus invades the T4 helper/inducer lymphocytes and multiplies, causing a breakdown in the body's immune system, eventually leading to overwhelming infection and/or cancer, with ultimate death.
Alkaline
A substance having a pH above that of neutral water (7.0) when in solution. Signified as pH (potential of Hydrogen), alkaline fluids, such as the blood (pH about 7.4), have the ability to neutralize acids (solutions below pH 7.0). Metabolic wastes are acids, and the alkaline reserve of the blood neutralizes them until they are excreted.
Anemia (Anaemia, Anemias)
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Bile
A bitter, yellow-green secretion of the liver. Bile is stored in the gallbladder and is released when fat enters the first part of the small intestine (duodenum) in order to aid digestion.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Celiac Disease (Gluten Sensitivity)
A digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten. Common symptoms include diarrhea, increased appetite, bloating, weight loss, irritability and fatigue. Gluten is found in wheat (including spelt, triticale, and kamut), rye, barley and sometimes oats.
Chemotherapy
A treatment of disease by any chemicals. Used most often to refer to the chemical treatments used to combat cancer cells. Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Most anticancer drugs are given by injection into a blood vessel (IV); some are given by mouth. Chemotherapy is a systemic therapy, meaning that the drugs enter the bloodstream and travel throughout the body. Usually, a patient has chemotherapy as an outpatient (at the hospital, at the doctor's office, or at home). However, depending on which drugs are given and the patient's general health, a short hospital stay may be needed.
Colon (Colonic)
The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.
Colonoscope (Colonoscopy)
A thin, flexible 'telescope' that is passed up from the anus in order to examine the bowels.
Computerised Tomography (CAT Scan, Computed Tomography, Computerized Axial Tomography, CT Scan)
A scanning procedure using X-rays and a computer to detect abnormalities of the body's organs. This technique provides cross-sectional images of body organs, which is much clearer than those provided by conventional X-rays.
Crohn's Disease (Crohn's)
Chronic inflammatory disease of the gastrointestinal tract. The most common symptoms are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia.
Diarrhea
Excessive discharge of contents of bowel.
Endoscopy
A procedure that uses an Endoscope: Examination with a flexible viewing tube.
Gastrointestinal (GI, GI Tract)
Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
Ileum
The lower two-thirds of the small intestine, ending in the ileocecal valve and emptying into the cecum of the colon. The last foot of the ileum is the only absorption site available for important dietary substances such as vitamin B12, folic acid, some essential fatty acids, fat soluble vitamins, and recycled bile acids.
Immune System (Immune Response, Immunity)
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation. The process may involve acquired immunity (the ability to learn and remember a specific infectious agent), or innate immunity (the genetically programmed system of responses that attack, digest, remove, and initiate inflammation and tissue healing).
Iron
An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.
Jaundice
Yellow discoloration of the skin, whites of the eyes and excreta as a result of an excess of the pigment bilirubin in the bloodstream.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Lymph Nodes (Axillary Nodes, Inguinal Nodes, Lymph Gland, Lymph Glands, Lymph Node, Lymphatic)
Small, bean-shaped nodes at various points throughout the body that function to filter the lymph fluid and attempt to destroy the microorganisms and abnormal cells which collect there. The most common locations are the neck (both sides and front), armpit (axillary) and groin (inguinal), but also under the jaw and behind the ears. Swollen or painful lymph nodes generally result from localized or systemic infection, abscess formation, or malignancy. Other causes of enlarged lymph nodes are extremely rare. Physical examination for lymph nodes includes pressing on them to check for size, texture, warmth, tenderness and mobility. Most lymph nodes can not be felt until they become swollen, and then will only be tender when pressed or massaged. A lymph node that is painful even without touching indicates greater swelling. Lymph nodes can usually be distinguished from other growths because they generally feel small, smooth, round or oval-shaped and somewhat mobile when attempts are made to push them sideways. Because less fat covers the lymph nodes in children, they are easier to feel, even when they are not busy filtering germs or making antibodies. Childrens' nodes enlarge faster, get bigger in response to an infection and stay swollen longer than an adult's. Also known (incorrectly) as lymph glands.
Lymphoma (Lymphomas)
Any tumor of the lymphatic tissues.
Malignant (Cancerous)
Dangerous. Mainly used to describe a cancerous growth -- when used this way, it means the growth is cancerous and predisposed to spreading.
Metastasize (Metastases, Metastasized, Metastasizes, Metastasizing, Metastatic)
Usually in reference to cancer: to spread, especially destructively.
Nausea
Symptoms resulting from an inclination to vomit.
pH
A measure of an environment's acidity or alkalinity. The more acidic the solution, the lower the pH. For example, a pH of 1 is very acidic; a pH of 7 is neutral; a pH of 14 is very alkaline.
Polyp (Polyps)
A usually nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder or intestine, often causing obstruction.
Prognosis
A prediction (estimate) of the future course and outcome of a disease and an indication of the likelihood of recovery from that disease.
Radiation Therapy (Radiotherapy)
The use of high-energy rays to kill cancer cells. Depending on the stage of the disease, treatment with radiation may be given alone or with chemotherapy. Radiation therapy is local therapy; it affects cancer cells only in the treated area. External radiation does not cause the body to become radioactive. Most often, treatment is given on an outpatient basis in a hospital or clinic.
Small Intestine (Small Bowel)
The small intestine lies between the stomach and the large intestine. It is about 6 meters (20 feet) long and its primary function is to digest (break down) food and absorb nutrients (vitamins, minerals, proteins, carbohydrates, and fats). The small intestine makes up more than 70% of the length and 90% of the surface area of the gastrointestinal (GI) tract.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Ultrasound
Ultrasound testing uses sound waves projected into the body to produce an image of internal organs, structures, tumors, etc. In this procedure, a gel is applied to the patient's skin, and a small device that emits ultrasonic pulses is slowly passed over the area. The sonic image produced is viewed on a monitor.
Last updated: Apr 13, 2008
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