Small Intestine Cancer

Key Points for This Section

  • Small intestine cancer is a rare disease in which malignant (cancer) cells form in the tissues of the small intestine.
  • There are five types of small intestine cancer.
  • Diet and health history can affect the risk of developing small intestine cancer.
  • Possible signs of small intestine cancer include abdominal pain and unexplained weight loss.
  • Tests that examine the small intestine are used to detect (find), diagnose, and stage small intestine cancer.
  • Certain factors affect prognosis (chance of recovery) and treatment options.

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

The small intestine is part of the body’s digestive system, which also includes the oesophagus, stomach, and large intestine. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The small intestine is a long tube that connects the stomach to the large intestine. It folds many times to fit inside the abdomen.

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Gastrointestinal (digestive) system anatomy; shows oesophagus, liver, stomach, colon, small intestine, rectum, and anus
Anatomy of the lower digestive system, showing the colon and other organs.

There are five types of small intestine cancer.

The types of cancer found in the small intestine are adenocarcinoma, sarcoma, carcinoid tumours, gastrointestinal stromal tumour, and lymphoma. This summary discusses adenocarcinoma and leiomyosarcoma (a type of sarcoma).

Adenocarcinoma starts in glandular cells in the lining of the small intestine and is the most common type of small intestine cancer. Most of these tumours occur in the part of the small intestine near the stomach. They may grow and block the intestine.

Leiomyosarcoma starts in the smooth muscle cells of the small intestine. Most of these tumours occur in the part of the small intestine near the large intestine.

Refer to the following summaries for more information on small intestine cancer:

  • Adult Soft Tissue Sarcoma Treatment
  • Childhood Soft Tissue Sarcoma Treatment
  • Adult Non-Hodgkin’s Lymphoma Treatment
  • Childhood Non-Hodgkin’s Lymphoma Treatment
  • Gastrointestinal Carcinoid Tumour Treatment

Diet and health history can affect the risk of developing small intestine cancer.

Risk factors include the following:

  • Eating a high-fat diet.
  • Having Crohn's disease.
  • Having celiac disease.
  • Having familial adenomatous polyposis (FAP).

Possible signs of small intestine cancer include abdominal pain and unexplained weight loss.

These and other symptoms may be caused by small intestine cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

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

Tests that examine the small intestine are used to detect (find), diagnose, and stage small intestine cancer.

Procedures that create pictures of the small intestine and the area around it help diagnose small intestine cancer and show how far the cancer has spread. The process used to find out if cancer cells have spread within and around the small intestine is called staging.

In order to plan treatment, it is important to know the type of small intestine cancer and whether the tumour can be removed by surgery. Tests and procedures to detect, diagnose, and stage small intestine cancer are usually done at the same time. The following tests and procedures may be used:

  • Physical exam and history. An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.
  • Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver disease that may be caused by small intestine cancer.
  • Abdominal x-ray: An x-ray of the organs in the abdomen. An x-ray is a type of energy beam that can go through the body onto film, making a picture of areas inside the body.
  • Barium enema: A series of x-rays of the lower gastrointestinal (GI) tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.

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Barium enema procedure; shows barium liquid being put into the rectum and flowing through the colon. Inset shows person on table having a barium enema.
Barium enema procedure. The patient lies on an x-ray table. Barium liquid is put into the rectum and flows through the colon. X-rays are taken to look for abnormal areas.

  • 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.

Fecal Occult Blood Test (FOBT) kit; shows card, applicator, and return envelope.
Fecal Occult Blood Test (FOBT) kit to check for blood in stool.

  • Upper endoscopy: A procedure to look at the inside of the oesophagus, stomach, and duodenum (first part of the small intestine, near the stomach). An endoscope (a thin, lighted tube) is inserted through the mouth and into the oesophagus, stomach, and duodenum. Tissue samples may be taken for biopsy.
  • Upper GI series with small bowel follow-through: A series of x-rays of the oesophagus, stomach, and small bowel. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the oesophagus, stomach, and small bowel. X-rays are taken at different times as the barium travels through the upper GI tract and small bowel.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. This may be done during the endoscopy. The sample is checked by a pathologist to see if it contains cancer cells.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerised tomography, or computerised axial tomography.
  • Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.
  • Laparotomy: A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken for biopsy.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The type of small intestine cancer.
  • Whether the cancer has spread to other places in the body.
  • Whether the cancer can be completely removed by surgery.
  • Whether the cancer is newly diagnosed or has recurred.

Stages of Small Intestine Cancer

Key Points for This Section

  • Tests and procedures to stage small intestine cancer are usually done at the same time as diagnosis.
  • Small intestine cancer is grouped according to whether or not the tumour can be completely removed by surgery.

Tests and procedures to stage small intestine cancer are usually done at the same time as diagnosis.

Staging is used to find out how far the cancer has spread, but treatment decisions are not based on stage. See the General Information section for a description of tests and procedures used to detect, diagnose, and stage small intestine cancer.

Small intestine cancer is grouped according to whether or not the tumour can be completely removed by surgery.

Treatment depends on whether the tumour can be removed by surgery and if the cancer is being treated as a primary tumour or is metastatic cancer.

Recurrent Small Intestine Cancer

Recurrent small intestine cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the small intestine or in other parts of the body.

Treatment Option Overview

Key Points for This Section

  • There are different types of treatment for patients with small intestine cancer.
  • Three types of standard treatment are used:
    • o Surgery
    o Radiation therapy
    o Chemotherapy
  • Other types of treatment are being tested in clinical trials. These include the following:
    • o Biologic therapy
    o Radiation therapy with radiosensitizers

    There are different types of treatment for patients with small intestine cancer.

    Different types of treatments are available for patients with small intestine cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

    Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

    Three types of standard treatment are used:

    Surgery

    Surgery is the most common treatment of small intestine cancer. One of the following types of surgery may be done:

    • Resection: Surgery to remove part or all of an organ that contains cancer. The resection may include the small intestine and nearby organs (if the cancer has spread). The doctor may remove the section of the small intestine that contains cancer and perform an anastomosis (joining the cut ends of the intestine together). The doctor will usually remove lymph nodes near the small intestine and examine them under a microscope to see whether they contain cancer.
    • Bypass: Surgery to allow food in the small intestine to go around (bypass) a tumour that is blocking the intestine but cannot be removed.

    Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

    Radiation therapy

    Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

    Chemotherapy

    Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

    Other types of treatment are being tested in clinical trials. These include the following:

    Biologic therapy

    Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

    Radiation therapy with radiosensitizers

    Radiosensitizers are drugs that make tumour cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumour cells.

    This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

    Treatment Options for Small Intestine Cancer

    Small Intestine Adenocarcinoma

    When possible, treatment of small intestine adenocarcinoma will be surgery to remove the tumour and some of the normal tissue around it.

    Treatment of small intestine adenocarcinoma that cannot be removed by surgery may include the following:

    • Surgery to bypass the tumour.
    • Radiation therapy as palliative therapy to relieve symptoms and improve the patient's quality of life.
    • A clinical trial of radiation therapy with radiosensitizers, with or without chemotherapy.
    • A clinical trial of new anticancer drugs.
    • A clinical trial of biologic therapy.

    This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about these and other ongoing clinical trials is available from the NCI Cancer.gov Web site.
    Small Intestine Leiomyosarcoma

    When possible, treatment of small intestine leiomyosarcoma will be surgery to remove the tumour and some of the normal tissue around it.

    Treatment of small intestine leiomyosarcoma that cannot be removed by surgery may include the following:

    • Surgery (to bypass the tumour) and radiation therapy.
    • Surgery, radiation therapy, or chemotherapy as palliative therapy to relieve symptoms and improve the patient's quality of life.
    • A clinical trial of new anticancer drugs.
    • A clinical trial of biologic therapy.

    This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about these and other ongoing clinical trials is available from the NCI Cancer.gov Web site.
    Recurrent Small Intestine Cancer

    Treatment of recurrent small intestine cancer that has spread to other parts of the body is usually a clinical trial of new anticancer drugs or biologic therapy.

    Treatment of locally recurrent small intestine cancer may include the following:

    • Surgery.
    • Radiation therapy or chemotherapy as palliative therapy to relieve symptoms and improve the patient's quality of life.
    • A clinical trial of radiation therapy with radiosensitizers, with or without chemotherapy.

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