Small Intestine Cancer Treatment

Parts of Small Intestine

Your small intestine is composed of three parts:

Most small intestinal cancers develop in either the duodenum or the ileum.

Types of Small Intestine Cancer

There are several types of small intestine cancer, including Adenocarcinoma, Neuroendocrine Tumors, Gastrointestinal Stromal Tumors (GIST), Lymphoma And Sarcoma. The different types of small intestine cancer are classified based on the type of cells where the cancer starts.

• Adenocarcinoma: Adenocarcinoma is one of the most common types of small intestine cancer. It begins in the glandular cells lining the intestine and often develops in the duodenum.
  Common symptoms: abdominal pain, nausea, vomiting, weight loss, jaundice, or intestinal blockage.
• Neuroendocrine Tumors (NETs): These tumors develop from neuroendocrine cells, which produce hormones and help regulate digestive functions. They commonly occur in the ileum. Some NETs grow slowly, while others can be more aggressive. Certain tumors may produce excess hormones, causing symptoms such as flushing, diarrhea, or wheezing.
• Lymphoma: Lymphoma of the small intestine develops from lymphocytes; a type of immune-system cell found in the intestinal wall. Several lymphoma subtypes can affect the small intestine, including non-Hodgkin lymphoma. Symptoms may include abdominal pain, weight loss, diarrhea, fever, or intestinal obstruction.
• Gastrointestinal Stromal Tumor (GIST): GISTs develop from specialized cells in the digestive tract called Interstitial Cells of Cajal or related precursor cells. They can occur anywhere along the gastrointestinal tract, including the small intestine. GISTs can be benign or malignant, although malignant GISTs can spread to other organs.
• Sarcoma: Sarcomas are cancers that develop from connective, muscle, or other supporting tissues. They are uncommon in the small intestine.

Causes of Small Intestine Cancer

Small intestine cancer occurs when abnormal cells in the small intestine begin to grow uncontrollably. The exact cause is not always known. However, certain conditions and risk factors may increase the likelihood of developing the disease.

Common Causes & Risk Factors:

Symptoms of Small Intestine Cancer

Small intestine cancer may not cause noticeable symptoms in its early stages. When symptoms develop, they can vary depending on the location and size of the tumour. Common Symptoms include:

Diagnosis of Small Intestine Cancer

Diagnosing small intestine cancer usually involves a combination of medical history, physical examination, imaging tests, endoscopic procedures, and laboratory tests. Since symptoms can resemble other digestive disorders, several tests may be needed to confirm the diagnosis and determine whether the cancer has spread.

• Medical History & Physical Examination: The doctor reviews symptoms such as abdominal pain, unexplained weight loss, persistent vomiting, changes in bowel habits, bleeding, or jaundice. A physical examination may help identify abdominal swelling, tenderness, or other abnormalities.
• Blood Tests: Blood tests may be performed to check:
  • Anaemia caused by internal bleeding
  • Liver and kidney function
  • General health and nutritional status
  • Certain tumour markers, when appropriate
  Blood tests alone cannot confirm small intestine cancer.
• Upper GI Endoscopy: A thin, flexible tube with a camera is passed through the mouth to examine the esophagus, stomach, and the first part of the small intestine (duodenum). If an abnormal area is found, a biopsy may be taken.
• Capsule Endoscopy: The patient swallows a small capsule containing a camera. As it travels through the digestive tract, it captures images of the small intestine. This can help identify abnormalities that may be difficult to reach with conventional endoscopy.
• CT Scan: A CT scan of the abdomen and pelvis can help identify a tumour, determine its size and location, and assess nearby lymph nodes or other organs for possible spread.
• MRI Scan: MRI may provide detailed images of the small intestine and surrounding tissues. It can be particularly useful for evaluating certain tumours and checking whether the cancer has spread.
• Enterography: CT Enterography or MR Enterography provides detailed images of the small bowel and can help detect masses, bowel-wall thickening, obstruction, or inflammation.
• Biopsy: A biopsy is usually the most important step for confirming cancer. During an endoscopic procedure or surgery, a small tissue sample is removed and examined under a microscope by a pathologist. The biopsy can help determine the type and characteristics of the cancer, which guides treatment planning.
• PET-CT Scan: A PET-CT may be recommended in selected cases to look for areas of increased metabolic activity and assess whether cancer has spread to other parts of the body. It is not required for every patient.
• Additional Tests for Staging: Once cancer is confirmed, additional imaging and tests may be performed to determine the stage of the cancer whether it is confined to the small intestine or has spread to lymph nodes or distant organs.

Treatments for Small Intestine Cancer

Treatment for small intestine cancer depends on the type of cancer, tumour location, stage, whether it can be completely removed, overall health, and whether it has spread to other organs. Surgery is the main treatment when the tumour is operable.

• 1. Surgery: Surgery is the most common treatment for small intestine cancer that can be completely removed.
  • Segmental resection: Removes the affected section of the small intestine along with nearby lymph nodes.
  • Whipple procedure: May be required for some cancers located in the duodenum.
  • Extended surgery: Nearby organs or portions of the colon may sometimes need to be removed if the tumour has spread.
  • Bypass surgery: May be performed when a tumour blocks the intestine but cannot be completely removed.
• 2. Chemotherapy: Chemotherapy uses anti-cancer medicines to destroy or control cancer cells. It may be recommended:
  • Before surgery (neoadjuvant chemotherapy) to shrink a tumour.
  • After surgery (adjuvant chemotherapy) to reduce the risk of recurrence.
  • For unresectable or metastatic cancer to control disease and relieve symptoms.
• 3. Radiation Therapy: Radiation therapy uses high-energy radiation to destroy cancer cells. It is not routinely required for every small intestine cancer, but may be considered in selected cases, particularly for certain duodenal cancers or when cancer cannot be completely removed. It may also help relieve symptoms caused by advanced disease.
• 4. Targeted Therapy: Targeted therapy uses medicines designed to attack specific molecular or genetic changes in cancer cells. It may be considered for advanced cancer when appropriate biomarkers or genetic alterations are identified.
• 5. Immunotherapy: Immunotherapy helps the body's immune system recognize and attack cancer cells. For some advanced small intestine adenocarcinomas, immune checkpoint inhibitors may be considered when testing shows dMMR (deficient mismatch repair) or MSI-H (microsatellite instability-high) characteristics.
• 6. Treatment for Advanced or Metastatic Cancer: When small intestine cancer has spread to distant organs or cannot be removed surgically, treatment may include chemotherapy, targeted therapy, immunotherapy, radiation therapy, palliative surgery, or clinical trials, depending on the cancer type and molecular profile. The aim may be to control disease, relieve symptoms and improve quality of life.
• 7. Clinical Trials: Because small intestine cancer is relatively rare, clinical trials may provide access to newer medicines and treatment approaches, particularly for advanced or recurrent disease.

FAQs of Small Intestine Cancer