Cancer of the Small Intestine
Symptoms of Small Bowel Cancer
Like most GI cancers, early symptoms of small intestine cancer tend to be vague and nonspecific. They may include abdominal discomfort associated with the following:
- Loss of appetite
The following symptoms may indicate advanced disease and should be signs to seek medical attention:
- Weight loss
- Iron deficiency anemia
- Visible blood loss: Blood or a material that looks like coffee grounds may be vomited, or black stools may be passed.
- Severe nausea and vomiting, due to a blockage in the small bowel by the enlarging cancer; small intestine cancer is often diagnosed during surgery for an unexplained bowel obstruction.
- Jaundice (yellowish skin): This is a symptom in people with cancer that involves the upper small intestine because of blockage of the bile ducts draining the liver. For example, stools may lighten in color, urine may darken, and the whites of the eyes appear yellow.
Diagnosing Cancer of the Small Intestine
In almost all cases, doctors first choose to perform a barium contrast study of the small intestine. This is also called a small bowel series. Other tests may include:
- Upper GI tract endoscopy to detect areas of concern in the immediate upper GI tract
- CT scan of the abdomen or an abdominal ultrasound to visualize bulky tumors and to evaluate possible spread of the cancer to adjacent lymph nodes and distant organs, such as the liver
- Colonoscopy to help diagnose tumors involving the lower areas of the small bowel
Treatment for Cancer of the Small Intestine
Surgical removal is the primary treatment for cancer of the small intestine. Other treatments may include:
- Chemotherapy, if the cancer has spread or is contained but advanced
- Radiation therapy, if the disease is localized at the place it originated
- Surgery may also relieve symptoms when the cancer has caused a bowel obstruction. In this case, doctors may perform a bypass procedure or limited tumor removal.
Prognosis for Small Bowel Cancer
Fewer than 35% of people who have adenocarcinoma of the small bowel live past five years.
- The survival chances are better if the cancer is limited to the inner walls of the small intestine and the lymph nodes are not involved.
- The chance of recovery is better still in people who have a carcinoid tumor or lymphoma of the small bowel. These malignancies tend to respond better to chemotherapy and/or radiation treatment when doctors cannot completely remove the tumor.
- The prognosis is poor, however, if a person has a small bowel lymphoma with underlying celiac disease or if the person's immune system is weakened.
Preventing Cancer of the Small Intestine
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's disease and small bowel bypass procedures also require immediate attention.
- Adenocarcinoma related to Crohn's disease frequently develops in the lower end of the small bowel, making colonoscopy a potentially useful screening tool.