Source: Cancer Resource Room
What is Small Bowel Cancer
Any cancer that starts in the small bowel (small intestine)
is called small bowel cancer. Cancers are formed by abnormal
cells that grow and divide without control. These cancer cells
replace normal cells and form a tumor or lump. As a tumor
gets bigger, it can grow into nearby tissues and organs. Cancer
cells can spread to other parts of the body through the blood
or lymph vessels. Most small bowel cancers start in the cells
that line the inside of the intestine. Tumor cells grow there,
invade through the layers of the small bowel, and spread to
lymph nodes and other tissues. Small bowel cancer is an uncommon
cancer, with about 2100 new cases a year in the United States.
What is the small intestine and what does it do?The small intestine links the stomach to the large intestine
It is divided into three parts:
- duodenum—part closest to the stomach
- jejunum—middle part
- ileum—part closest to the colon
The small intestine is separated from the stomach by a circle
of muscle called the pylorus. The pylorus controls the flow
of food and fluid from the stomach into the small intestine.
In the duodenum, food is processed and broken down into particles
that can be absorbed for nutrition. The jejunum completes
the chemical digestion of food and absorbs a lot of nutrients.
The ileum absorbs nutrients and water. There is another circle
of muscle where the ileum joins the large intestine. It is
called the ileocecal valve and controls the flow of fluid
from the small to the large bowel.
There are four layers of tissue that make up the small intestine:
- inside lining (mucosa)
- support tissue for lining (submucosa)
- muscle (muscularis)
- outside covering layer (serosa)
Small bowel cancer usually starts in the lining layer. It
grows larger and deeper through the other layers, spreading
to nearby tissues and lymph nodes. The intestines can keep
working even though a cancer has started in one part of it.
This means a small bowel cancer can get quite large or deep
before it is diagnosed.
Is there only one type of small bowel cancer?
Not all small bowel cancers are the same. The most common
are called adenocarcinomas (gland-forming cancers). They mostly
occur in the duodenum. Two types of cancers that are found
in the ileum are called carcinoid tumors and lymphoma. A fourth
type of small bowel cancer is called sarcoma and occurs throughout
the small intestine.
What are the symptoms of
small bowel cancer?
Symptoms of small bowel cancer are caused by the
tumor taking up space inside the intestine and disturbing
its normal functions. A tumor can cause a blockage or obstruction
so the digesting food cannot pass by easily. The cancer tissue
can also bleed into the intestine. Some symptoms are caused
by cancer cells invading the layers of the small bowel or
spreading to other tissues nearby. Small bowel cancer usually
grows for some time before it causes any symptoms. And the
symptoms can be similar to some common problems, such as irritable
bowel syndrome and peptic ulcer disease. What makes symptoms
from cancer different are:
- having a variety of symptoms for several weeks,
- having the same symptoms for several weeks, and (3) older
age (more than 50 years old). When symptoms occur they include:
- abdominal discomfort or pain
- weight loss (without dieting)
- weakness or tiredness (due to anemia—a low blood
- nausea and vomiting
- bloody or black, sticky bowel movements
- lump in the abdomen
- jaundice (yellow skin color)
- loss of appetite
These symptoms often have other causes and should be checked
by a doctor.
How is small bowel cancer
A patient’s medical history and physical exam are the
first steps in making a diagnosis of any disease. The medical
history includes many details of a person’s health.
In particular, the history will focus on the digestive tract—changes
in eating habits, changes in bowel movements, abdominal pain
or bloating, and how food affects any of the symptoms. In
the case of small bowel cancer the patient’s history
may also include information about other diseases such as
Crohn’s disease, adult celiac disease, familial polyps
of the digestive tract, Peutz-Jeghers syndrome, or previous
The physical exam will focus on areas of discomfort in the
abdomen, the presence of a mass (a lump) in the abdomen, an
enlarged liver, fluid or swelling in the abdomen, any skin
color change (yellow jaundice), or enlarged lymph nodes. The
stool must be checked for blood.
After the history and physical exam, some diagnostic tests
may be ordered. Blood tests and a chest x-ray check a patient’s
general health. Blood tests that may be done include:
- Blood count - to check for anemia
- Liver enzymes- for possible spread to the liver or blockage
of the bile duct
- CEA - marker protein that may increase
Special tests that are useful in diagnosing small
bowel cancer are:
- Upper GI with Small Bowel Follow-Through (barium contrast
study)—an x-ray test in which the patient swallows
a liquid containing barium. The barium, a white liquid,
goes down the esophagus to the stomach and on into the small
intestine. It lines the inside layer of all these structures.
X-rays are then taken of the abdomen. The x-rays can show
small changes in the smooth inner surface of the small bowel.
This study is done in the radiology department of a hospital.
The test is painless, but the barium liquid is unpleasant
to drink. Barium can cause constipation and makes a person’s
bowel movements white or light-colored for a few days.
- CT scan—x-rays made in thin cross-sections of the
small intestine and surrounding tissues. This set of x-rays
can show a tumor in the small bowel, as well as its spread
to nearby tissues and lymph nodes.
- Endoscopy—a flexible tube with a tiny camera in
it is passed down the patient’s throat, down the esophagus,
through the stomach and into the duodenum. The camera transmits
pictures of the inside of these structures to a TV screen.
If an abnormal spot of tissue is “seen” with
the camera, a small clipper inside the end of the tube takes
a sample of the tissue for diagnosis. This sample is called
a biopsy. Of the entire small bowel, only the duodenum can
be viewed by endoscopy. Many biopsy samples can be taken
during an endoscopy. The procedure is done using sedation
(a strong relaxing medication) given through an IV. After
the endoscopy, the patient feels sleepy from the medication,
may have a mild sore throat from the tube, but is fine after
the medicine wears off. It will take several days to get
the results from the biopsy.
- Colonoscopy—similar to endoscopy, this test uses
a thin, flexible tube with a camera in it to look at the
inside of the colon (large intestine) and the end of the
small intestine, the ileum. In preparation for the test,
the patient drinks only liquids the day before, including
a fluid that helps clean out the bowel. The procedure is
done using sedation for relaxation. The colonscope is passed
through the anus and rectum into the colon and up through
the large intestine into the end of the small bowel. The
procedure is done using sedation for relaxation. It is not
a painful procedure and does not require anesthesia.
These tests are useful in about 50% of patients with small
bowel cancer. Many patients are operated on even though the
test results are questionable. This is because the history,
symptoms, and physical exam all suggest a diagnosis of small
What is a biopsy? What does it mean to the patient?
A biopsy is a small piece of tissue or group of cells used
to diagnose a disease. The tissue is taken from a spot suspected
of being abnormal. Then the biopsy tissue is looked at under
a microscope by a pathologist. The diagnosis is based on the
appearance of the tissue and cells. The biopsy result helps
plan the patient’s treatment.
What if the biopsy shows small bowel cancer?
If the biopsy shows cancer, the next step is to find out how
much disease there is. In particular, you need to know:
- how widespread is the disease in the small bowel
- how many layers has it spread through
- has it spread beyond the small bowel into the lymph nodes,
into nearby tissues, or to distant lymph nodes and other
What tests are used to find the spread of small bowel
- CT scans—these are x-rays that show cross-section
pictures of the body. CT images let the radiologist see
the stomach and other organs in many ways, going across,
as well as up and down the body. An abdominal CT scan shows
the stomach, lymph nodes, liver, gallbladder and bile ducts,
pancreas, small and large intestines, kidneys, major blood
vessels, and part of the spine. The patient may need to
drink a contrast solution to help outline the digestive
organs. An IV is used to give the patient contrast “dye”
that travels through the blood. Contrast dye in the blood
makes a person feel very warm for a brief time, and causes
a sensation of needing to pee urgently. Both feelings pass
quickly. CT scans are not painful, but do require lying
on a table for about 30 minutes.
- Laparoscopy—this procedure lets the surgeon look
inside the abdomen with a laparoscope, a thin tube with
a small camera in the end. The laparoscope is inserted through
a small abdominal incision. It transmits pictures from inside
the abdomen to a TV monitor so the surgeon can see what
tissues look normal and which do not. This helps plan the
patient’s surgery and other treatments. Laparoscopy
is done in the operating room with the patient under general
The information about the patient, including the medical
history, physical exam, blood tests, x-rays, special scans,
and procedures, are used to describe the patient’s
stage of disease and plan the best treatment for that disease.
What is the stage of a cancer? How is it determined?
The stage of a cancer describes how much cancer there is,
what tissue it has invaded, and whether or not it spread to
lymph nodes and other parts of the body. The higher the stage,
the more complicated the disease. The stage is a combination
of the size or extent of tumor growth, the number of lymph
nodes involved, and the spread to other sites (metastases).
These are the stages for adenocarcinoma of the small bowel:
- Stage 0: cancer cells are only in the lining layer (in
the mucosa) and have not invaded the outer layers or lymph
nodes. May be called, “carcinoma in situ.”
- Stage I: cancer has invaded from the lining layer into
the submucosa or as far as the muscle layer. Cancer has
not grown into any lymph nodes.
- Stage II: cancer has invaded the muscle layer, serosa,
and into nearby tissue, but has not spread to lymph nodes.
- Stage III: cancer has grown through all layers of the
intestine, into nearby tissues, and to lymph nodes. Cancer
has not traveled to distant nodes or organs.
- Stage IV: cancer has spread to other parts of the body
(liver, lungs, bones, brain).
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