Small Intestine Cancer

Small intestine cancer is a rare disease in which malignant (cancer) cells form in the tissues of the small intestine.

• The small intestine, a long tube (about 20 feet long) connecting the stomach to the large intestines, is part of the body's digestive system which also includes the esophagus, stomach, and large intestine. It folds many times to fit inside the abdomen.
• The small intestine has 3 sections.
  • The duodenum: This is the first section and is only about a foot long. A short distance from where the duodenum attaches to the stomach, the pancreatic duct and bile duct enter the duodenum at the ampulla of Vater. Fluids from the pancreas and liver enter the small intestine here, helping to further digest the food.
  • The jejunum and ileum: These parts make up most of the small intestine, and are where most of the nutrients in food are absorbed into the bloodstream.
    • The ileum empties into the colon (the first part of the large intestine). This muscular tube is about 4 to 5 feet long. It absorbs water and some remaining mineral nutrients from the food matter.
• Small intestine cancers are much less common than most other types of GI cancers (such as colon, rectal, stomach, and esophagus cancers) in the United States.
• There are four major types of small intestine cancer.
  • Adenocarcinoma
    • Starts in glandular cells in the lining of the small intestine
    • They account for about 1 in 3 small intestine cancers
    • Most of these tumors occur in the part of the small intestine near the stomach.
    • They may grow and block the intestine.
  • Sarcoma,
    • These are cancers that start in connective tissues, such as muscle.
    • The most common sarcomas in the intestine are known as gastrointestinal stromal tumors (GISTs).
  • Carcinoid tumors,
    • These tumors are a type of neuroendocrine tumor (NET), and they tend to be slow growing.
    • They are the most common type of small intestine tumor.
  • lymphoma.
    • Starts in the smooth muscle cells of the small intestine.
    • Most of these tumors occur in the part of the small intestine near the large intestine.
• Most experts think that cancer of the small intestine develops much like colorectal cancer. It first begins as a small growth on the inner lining of the intestine, called a polyp. Over time, the polyp can change into a cancer.
• Most small intestinal cancers (especially adenocarcinomas) develop in the duodenum. Cancers that develop in the duodenum are often found at the ampulla of Vater. But because this area is closely associated with the pancreas, cancers of the ampulla of Vater (also known as ampullary cancers) are treated like pancreatic cancer.
• Diet and health history can affect the risk of developing small intestine cancer.
  • Risk factors include
    • Eating a high fat diet
    • Having Crohn disease
    • Having celiac disease
    • Having familial adenomatous polyposis (FAP)
    • Having lymphedema (damage to the vessels that connect to the lymph nodes)
    • Average age at diagnosis is 60
    • Men have a slightly higher risk

Signs and symptoms (See doctor, esp. if notice / experience any of the first four!!!)

• Pain or cramps in the middle of the abdomen
• Weight loss with no known reason
• A lump in the abdomen
• Blood in the stool; dark-colored stools (from bleeding into the intestine)
• Nausea and vomiting
• Anemia--low red blood cell counts
• Yellowing of the skin and eyes (jaundice)

Diagnosis

• Various tests that examine the small intestine are used to detect (find), diagnose, and stage small intestine cancer and can be difficult to diagnose.
  • Tests might include lab tests, X-rays, a CT scan, MRI, or PET scans.
  • Some tests & procedures to stage the cancer are usually done at the same time.

Cancer may spread from where it began to other parts of the body.

• There are three ways that cancer spreads in the body:
  • Tissue: The cancer spreads from where it began by growing into nearby areas.
  • Lymph system: The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body, where it can form a metastatic tumor.
  • Blood: The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body and forms a tumor (metastatic tumor) in another part of the body.
• When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
• The metastatic tumor is the same type of cancer as the primary tumor.

Treatment

• Depends on whether the tumor can be removed by surgery and if the cancer is being treated as a primary tumor or is metastatic cancer.

Prognosis

• The following factors affect prognosis (chance of recovery) and treatment options.
  • The type of small intestine cancer.
  • Whether the cancer is in the inner lining of the small intestine only or has spread into or beyond the wall of the small intestine.
  • Whether the cancer has spread to other places in the body, such as the lymph nodes, liver, or peritoneum (tissue that lines the wall of the abdomen and covers most of the organs in the abdomen).
  • Whether the cancer can be completely removed by surgery.
  • Whether the cancer is newly diagnosed or has recurred.
• The survival for resectable small bowel adenocarcinoma is only 20%.
• A majority of people who have adenocarcinoma of the small bowel live past 5 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 which is a slower growing form of cancer. The survival rate for resectable sarcoma of the smooth muscle of the small intestine called leiomyosarcoma is 50%.
• Non-Hodgkin's lymphoma of the small bowel tends to respond better to chemotherapy than do other types of small intestinal cancer. Survival varies with the subtypes of the lymphoma and other areas found to be involved when lymphoma is diagnosed.
• The prognosis is poor, however, if a person has a small bowel lymphoma underlying celiac disease or if the person'simmune system is weakened.

Statistics:

• From: NIH - Cancer Stat Facts: Small Intestine Cancer
  • Number of New Cases and Deaths per 100,000: The number of new cases of small intestine cancer was 2.4 per 100,000 men and women per year. The number of deaths was 0.4 per 100,000 men and women per year. These rates are age-adjusted and based on 2012-2016 cases and deaths.
• From: American Cancer Society - Key Statistics for Small Intestine Cancer
  • Although the small intestine makes up the largest part of the gastrointestinal (GI) tract, small intestine cancers are rare in the United States. In fact, they account for fewer than 1 in 10 cancers of the gastrointestinal (GI) tract, and fewer than 1 in 100 cancers overall.
  • The American Cancer Society estimates for these cancers in the United States for 2019 are:
    • About 10,590 people (5,610 men and 4,980 women) in the United States will be diagnosed with some type of small intestine cancer.
    • About 1,590 people (890 men and 700 women) will die of small intestine cancer.
• From Cancer.Net - Small Bowel Cancer: Statistics. Jan 2019
  • The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for all types of small bowel cancer is 68%.
  • When detected at an early stage, the 5-year survival rate for small bowel cancer is 85%. If small bowel cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 75%. If the cancer has spread to a distant part of the body, the 5-year survival rate is 42%.
• From: Research UK - Small intestine cancer statistics
  • There are around 500 small intestine cancer deaths in the UK every year, that's more than 1 every day (2014-2016).
  • Small intestine cancer is not among the 20 most common causes of cancer death in the UK, accounting for less than 1% of all cancer deaths (2016).
  • In males in the UK, small intestine cancer is the 19th most common cause of cancer death, with around 280 deaths in 2016.
  • In females in the UK, small intestine cancer is not among the 20 most common causes of cancer death, with around 240 deaths in 2016.
  • Mortality rates for small intestine cancer in the UK are highest in people aged 85 to 89 (2014-2016).
  • Since the early 1970s, small intestine cancer mortality rates have increased by almost two-fifths (37%) in the UK. Rates in males have increased by almost half (46%), and rates in females have increased by more than a quarter (28%).
  • Over the last decade, small intestine cancer mortality rates have increased by almost a third (31%) in the UK. Rates in males have increased by almost a third (31%), and rates in females have increased by more than a quarter (29%).

Resources & Additional Reading

• NIH - Small Intestine Cancer Treatment (PDQ®) - Patient Version
• American Cancer Society - What is a Small Intestine Cancer?
• Web MD - What is Small Intestine Cancer?
• Cancer.Net - Small Bowel Cancer: Survivorship. Approved by the Cancer.Net Editorial Board, 8/2018
• Mayo Clinic - Small bowel cancer
• EMedicinehealth = Cancer of the Small Intestines. Medical Author: Robert J Fingerote, MD, MSc, BSc
• YouTube - Intestinal Cancer (Small Bowel Adenocarcinoamas, Sarcomas, Carcinoids, GISTs and Lymphomas (16 min)

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