The small intestine is the portion of the digestive system most responsible for absorption of nutrients from food into the bloodstream. The pyloric sphincter governs the passage of partly digested food from the stomach into the duodenum. This short first portion of the small intestine is followed by the jejunum and the ileum. The ileocecal valve of the ileum passes digested material into the large intestine

Cancer of the small intestine, a rare cancer, is a disease in which cancer cells are found in the tissues of the small intestine. The small intestine is a long tube that folds many times to fit inside the abdomen. It connects the stomach to the large intestine (bowel). In the small intestine, food is broken down to remove vitamins, minerals, proteins, carbohydrates, and fats.

A doctor should be seen if there are any of the following:

• Pain or cramps in the middle of the abdomen.
• Weight loss without dieting.
• A lump in the abdomen.
• Blood in the stool.

If there are symptoms, a doctor will usually order an upper gastrointestinal x-ray (also called an upper GI series). For this examination, a patient drinks a liquid containing barium, which makes the stomach and intestine easier to see in the x-ray. This test is usually performed in a doctor’s office or in a hospital radiology department.

The doctor may also do a CT scan, a special x-ray that uses a computer to make a picture of the inside of the abdomen. An ultrasound, which uses sound waves to find tumours, or an MRI scan, which uses magnetic waves to make a picture of the abdomen, may also be done.

The doctor may put a thin lighted tube called an endoscope down the throat, through the stomach, and into the first part of the small intestine. The doctor may cut out a small piece of tissue during the endoscopy. This is called a biopsy. The tissue is then looked at under a microscope to see if it contains cancer cells.

The chance of recovery (prognosis) depends on the type of cancer, whether it is just in the small intestine or has spread to other tissues, and the patient’s overall health.

Stages of cancer of the small intestine
Once small intestine cancer is found, more tests will be done to find out if cancer cells have spread to other parts of the body. Although there is a staging system for cancer of the small intestine, for treatment purposes this cancer is grouped based on what kind of cells are found. The types of cancer found in the small intestine include adenocarcinoma, sarcoma, and carcinoid tumours.
 
Adenocarcinoma
Adenocarcinoma starts in the lining of the small intestine and is the most common type of cancer of the small intestine. These tumours occur most often in the part of the small intestine nearest the stomach. These cancers often grow and block the bowel.

Leiomyosarcoma
Leiomyosarcomas are cancers that start growing in the smooth muscle lining of the small intestine.

Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the small intestine or in another part of the body.

How cancer of the small intestine is treated

There are treatments for all patients with cancer of the small intestine. Three kinds of treatment are used:

• Surgery (taking out the cancer).
• Radiation therapy (using high-dose x-rays to kill cancer cells).
• Chemotherapy (using drugs to kill cancer cells).

Surgery to remove the cancer is the most common treatment. Lymph nodes in the area may also be removed and looked at under a microscope to see if they contain cancer. If the tumour is large, a doctor may cut out a section of the small intestine containing the cancer and reconnect the intestine.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumours. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). Drugs that make the cancer cells more sensitive to radiation (radio sensitizers) are sometimes given along with radiation. Radiation can be used alone or in addition to surgery and/or chemotherapy.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put in the body through a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the intestine.

If the doctor removes all the cancer that can be seen at the time of the operation, the patient may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after an operation is called adjuvant chemotherapy.

Biological therapy (using the body’s immune system to fight cancer) is being studied in clinical trials. Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body’s natural defences against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

Small Intestine Adenocarcinoma

Treatment may be one of the following:

1. Surgery to cut out the tumour.
2. Surgery to allow food in the small intestine to go around the cancer (bypass) if the cancer cannot be removed.
3. Radiation therapy to relieve symptoms.
4. A clinical trial of radiation plus drugs to make cancer cells more sensitive to radiation (radio sensitizers), with or without chemotherapy.
5. A clinical trial of chemotherapy or biological therapy.

Small Intestine Leiomyosarcoma

Treatment may be one of the following:

1. Surgery to remove the cancer.
2. Surgery to allow food in the small intestine to go around the cancer (bypass) if the cancer cannot be removed.
3. Radiation therapy.
4. Surgery, chemotherapy, or radiation therapy to relieve symptoms.
5. A clinical trial of chemotherapy or biological therapy.

Recurrent Small Intestine Cancer

If the cancer comes back in another part of the body, treatment will probably be a clinical trial of chemotherapy or biological therapy.

If the cancer has come back only in one area, treatment may be one of the following:

1. Surgery to remove the cancer.
2. Radiation therapy or chemotherapy to relieve symptoms.
3. A clinical trial of radiation with drugs to make the cancer cells more sensitive to radiation (radio sensitizers), with or without chemotherapy.

BACK