Small Intestine Cancer

Small Intestine Cancer

Small Intestine Overview

The small intestine is part of the digestive system, also known as the small bowel. It plays a key role in absorbing nutrients from food into the bloodstream. The small intestine connects the stomach to the large intestine and is divided into three parts:

• Duodenum: The section closest to the stomach.

• Jejunum: The middle part.

• Ileum: The final section that connects to the large intestine.

The small intestine is over 4 meters long, making up about 75% of the digestive tract.

Cancer occurs when healthy cells in the small intestine grow uncontrollably, forming a tumor. These tumors may be benign (non-cancerous) or malignant (cancerous).

Types of Small Intestine Cancer

The main types include:

1. Adenocarcinoma:

• The most common type.

• Typically develops in the duodenum or jejunum from glandular cells lining the intestine.

2. Sarcoma:

• Arises in the muscle tissue of the small intestine.

• Leiomyosarcoma is a common type, often found in the ileum.

3. Gastrointestinal Stromal Tumor (GIST):

• A rare cancer that develops from interstitial cells of Cajal (ICC) in the intestinal wall.

• Classified as a soft tissue sarcoma.

4. Neuroendocrine Tumor (NET):

• Originates from hormone-producing cells, commonly in the ileum.

5. Lymphoma:

• A cancer of the lymphatic system, often occurring in the jejunum or ileum.

• Non-Hodgkin lymphoma is the most frequent type affecting the small intestine.

Adenocarcinoma - Primary Focus

Adenocarcinoma is the most common type of small intestine cancer. Below are its key details:

Statistics

• In the United States, about 12,070 cases of small intestine cancer are diagnosed annually.

Survival Rate

• 5-year survival rate: 69%

• If diagnosed in the early stage, the survival rate increases to 84%.

Risk Factors

Factors that increase the risk of small intestine cancer include:

1. Crohn’s Disease:

• Chronic inflammation of the digestive tract that can affect the small intestine.

2. Celiac Disease:

• A disorder where gluten consumption damages the small intestine, impairing nutrient absorption.

3. Familial Adenomatous Polyposis (FAP):

• A hereditary condition where numerous polyps form in the intestines, with a high chance of developing cancer.

Symptoms

• Blood in the stool

• Dark-colored stool

• Diarrhea

• Abdominal lump or mass

• Abdominal pain

• Unexplained weight loss

• Severe nausea or vomiting accompanied by abdominal pain

Diagnosis

1. Blood Tests:

• Check for anemia due to internal bleeding and assess liver and kidney functions.

2. Biopsy:

• Removal and microscopic examination of tissue to confirm cancer.

3. Endoscopy:

• A thin tube with a light is passed through the mouth to examine the esophagus, stomach, and small intestine. If abnormalities are found, a biopsy is performed.

• Video Capsule Endoscopy (VCE): The patient swallows a capsule containing a camera that captures images of the small intestine.

4. Colonoscopy:

• Similar to endoscopy, but the tube is inserted through the rectum to examine the small intestine.

5. Imaging Tests:

• X-ray, CT scan, PET CT, and Laparotomy to detect cancerous growths.

Treatment Options

1. Surgery

• The primary treatment for small intestine cancer.

• Surgery involves removing the tumor along with some surrounding healthy tissue (margin).

• Additional procedures may be performed to reconnect the intestines or remove affected lymph nodes.

• Post-surgery recovery: Patients may experience digestive issues such as diarrhea, constipation, or abdominal pain, which improve over time.

2. Chemotherapy

• Uses drugs to kill cancer cells.

• Common chemotherapy drugs for small intestine cancer include:

• Fluorouracil (5-FU) with leucovorin (folinic acid)

• FOLFOX: 5-FU, leucovorin, and oxaliplatin

• FOLFIRI: 5-FU, leucovorin, and irinotecan

• CAPEOX: Capecitabine and oxaliplatin

• FOLFOXIRI: A combination of 5-FU, leucovorin, oxaliplatin, and irinotecan

• Neoadjuvant Therapy: Chemotherapy given before surgery to shrink the tumor.

• Chemoradiation: Chemotherapy combined with radiation therapy.

Side Effects: Fatigue, nausea, vomiting, hair loss, infections, and diarrhea.

3. Immunotherapy

• Stimulates the immune system to fight cancer cells.

• Recommended for cases with high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR).

• Common drugs:

• Pembrolizumab (Keytruda)

• Nivolumab (Opdivo)

• Ipilimumab (Yervoy)

• Dostarlimab (Jemperli)

4. Targeted Therapy

• Focuses on specific proteins or genetic mutations in cancer cells.

• Common targeted therapy drugs:

• Bevacizumab

• Larotrectinib

• Entrectinib

5. Radiation Therapy

• Uses high-energy radiation to kill cancer cells.

• Not commonly used as a primary treatment for small intestine cancer.

• Often used with chemotherapy to reduce tumor size (chemoradiation) or as palliative care.

Side Effects: Fatigue, skin irritation, diarrhea, and digestive discomfort.

Follow-up Care

After treatment, regular follow-up appointments are essential to monitor for recurrence and manage side effects. Follow-up care includes:

• Physical examinations

• Blood tests

• Imaging tests

Small intestine cancer, though rare, is treatable if detected early. Advances in surgery, chemotherapy, and targeted therapies have improved survival rates significantly. Regular follow-ups help ensure long-term well-being and detect any signs of recurrence early.

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