There are three primary treatments for patients with cancer of the small intestine: surgery, radiation therapy and chemotherapy. Biological therapy (using the body’s immune system to fight cancer) is being studied in clinical trials.

Surgery

Surgery to remove the cancer is the most common treatment. Lymph nodes in the area may also be removed and looked at under a microscope to see if they contain cancer. If the tumor is large, a doctor may cut out a section of the small intestine containing the cancer and reconnect the intestine.

Radiation Therapy

In radiation therapy, also called radiotherapy, a machine delivers radiation to the affected area and, in some cases, to the nearby lymph nodes. While the actual treatment takes only a few minutes, it is usually scheduled 5 days a week for 5 to 6 weeks.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes directly into the area where the cancer cells are found (internal radiation therapy).

Radiation therapy may be used alone or in combination with chemotherapy or surgery.

Side Effects of Radiation Therapy

Radiation therapy targets specific areas where cancer cells have formed tumors. However, it can also affect healthy cells in the immediate vicinity. As a result, some side-effects may occur. The most common include:

Skin damage: The skin in the treated area may be somewhat sensitive and therefore should be protected against exposure to sunlight and irritation. Also, your physician may prescribe baby powder or cornstarch, an antibiotic ointment, or steroid cream to relieve itching and pain and to speed healing

Hair loss: Hair is frequently lost from the area receiving the radiation therapy. However, the hair will grow back once treatment is finished.

Nausea, vomiting and headaches: These side-effects can occur following radiation therapy to specific sites, such as the head or abdomen. They can often be relieved and sometimes prevented by certain medications.

Other side effects may occur depending on the specific area being treated.

Chemotherapy

Chemotherapy refers to the use of chemical agents to destroy cancer cells. Chemotherapy drugs travel throughout the body to slow the growth of cancer cells or kill them.

Chemotherapy drugs can be given orally (pills or liquids) or by injection. Chemotherapy treatment is generally spaced out over an extended period (typically every three to four weeks) to gradually lower the number of tumor cells while allowing healthy cells to recover. Many patients receive their chemotherapy over a four- to 12- month period.

Combination chemotherapy combines two or more chemotherapy drugs that differ in both the ways they act and their side effects. This is done to achieve maximum tumor reduction with minimal side effects. Because tumor cells have different biological characteristics, combining drugs may effectively eliminate cancer cells’ resistance to a single drug.

Adjuvant chemotherapy is chemotherapy given when no clear evidence of cancer can be found, but certain factors (e.g., metastasis or spread to the lymph nodes) predict an increased risk of cancer recurrence.

Side Effects of Chemotherapy

Chemotherapy drugs are designed to seek out and destroy rapidly-dividing cancer cells. However, they also affect fast-growing normal cells such as those in the gastrointestinal tract, bone marrow, hair follicles, and reproductive system. Because of this, unwanted side effects of the treatment can and often do occur. Most side effects, however, are temporary.

Some of the more common side-effects of chemotherapy include:

Nausea and vomiting: This is caused by several chemotherapy drugs, but can often be relieved and sometimes prevented by certain medications.

Hair loss: This will occur in varying degrees, depending on which chemotherapy drugs and which schedule of drugs are received. However, the hair will grow back once treatment is finished.

Fatigue and Infection: Chemotherapy can reduce the bone marrow’s ability to produce the normal amount of blood cells. This may put you at greater risk for anemia (if significantly fewer red blood cells are being produced), bleeding (if production of platelets is down), or infection (if the white cell count, particularly that of the neutrophils, is low). However, medications are available which can stimulate blood cell production.

Biological Therapy

Biological therapy (using the body’s immune system to fight cancer) is being studied in clinical trials. Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body’s natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

Clinical Trials

Clinical trials are studies that evaluate the effectiveness of new treatments. Depending on what is being studied, a particular clinical trial may involve patients with cancer or people who do not have cancer but are at higher risk than most people for developing it.

Most clinical research that involves the testing of a new drug progresses in an orderly series of steps called phases. Generally, a particular cancer clinical trial falls into one of three phases.

—      Phase I – Tests the best way (how much, how often) to give a new treatment and how much can be given safely.

—      Phase II – Evaluates how well a treatment works and provides additional information on safety.

—      Phase III – Compares a promising new drug, combination of drugs or procedure with the current standard treatment.

If you participate in a Phase III clinical trial, you are likely be randomized (assigned by chance) to a group receiving either the current standard treatment or the new treatment being evaluated. Trials designed in this way are also called randomized controlled trials.

It takes time, often several years, for clinical trials to prove the true value and effectiveness of a new treatment. However, clinical-study patients receive the best care possible, and if a treatment does not seem to be helping, a patient can be taken out of a study.

If you take part in a clinical trial, you may benefit from a new drug, procedure, or symptom-control method while helping scientists evaluate its effectiveness. Your participation may also contribute directly to finding better ways to prevent, detect, or treat the disease. Many of today’s most effective interventions are the direct result of knowledge gained through clinical trials.

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Also bowels, in higher animals, the portion of the digestive tract between the stomach and anus. In humans the intestine is divided into two major sections: the small intestine, which is about 6 m (20 ft) long, where the most extensive part of digestion occurs and where most food products are absorbed; and the large intestine, which has a larger diameter and is about 1.5 m (5 ft) long, where water is absorbed and from which solid waste material is excreted (see Digestive System; Feces).

The small intestine, which is coiled in the center of the abdominal cavity (see Abdomen), is divided into three sections. The upper portion includes the pylorus, the opening at the lower part of the stomach, through which the contents of the stomach pass into the duodenum. The duodenum is a horseshoe-shaped section surrounding part of the pancreas and the pancreatic duct, as well as ducts from the liver and gall bladder that open into it. The middle part of the small intestine, extending from the duodenum to the ileum, is called the jejunum, and the terminal portion is the ileum, which leads into the side of the first part of the large intestine, the cecum. The lining membrane, or mucosa, of the small intestine is especially suited for the purpose of digestion and absorption. The mucosa is folded; the folds are covered with minute mucosal projections called villi. Each villus is a small tube of epithelium surrounding a small lymphatic vessel, or lacteal, and many capillaries. Tiny glandular pits, called the crypts of Lieberkühn, open at the bases of the villi; these pits secrete the enzymes necessary for intestinal digestion. Digested carbohydrates and proteins pass into the capillaries of the villi and then to the portal vein, which enters the liver; digested fats are absorbed into the lacteals in the villi, and they are transported through the lymphatic system into the general bloodstream. The lining of the small intestine also secretes a hormone called secretin, which stimulates the pancreas to produce digestive enzymes.

The large intestine is divided into the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. The cecum is a swollen sac located in the lower right-hand portion of the abdominal cavity; it is very large in herbivorous animals. The two important parts of the cecum in humans are the vestigal vermiform appendix (see Appendicitis), which often becomes diseased; and the ileocecal valve, a membranous structure between the cecum and the small intestine that regulates the passage of food material from the small intestine to the large intestine and also prevents the passage of toxic waste products from the large intestine back into the small intestine. The ascending colon rises along the right side of the abdominal cavity; the transverse colon runs across the body to the left side, where the descending colon travels downward. The sigmoid colon is the S-shaped portion of the large intestine as it enters the pelvic cavity. The rectum, about 15 cm (6 in) long, is the almost straight, terminal portion of the large intestine. At the exit of the rectum, called the anus, is a round muscle, the anal sphincter, that closes the anus. The large intestine has a smooth mucosal lining (only the rectum has folds) that secretes mucus to lubricate the waste materials.

Food and waste material are moved along the length of the intestine by rhythmic contractions of intestinal muscles; these contractions are called peristaltic movements. The entire intestine is held in place in the abdominal cavity by membranes called mesenteries.

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One of the first issues for a newly diagnosed patient is to consider whether the diagnosis is correct. It is important to validate a diagnosis and be certain of its accuracy. On the other hand, hoping for a misdiagnosis should not be used as a way to vaccilate and avoid treatment for a serious medical problem. Nevertheless, it is prudent to attempt to confirm a diagnosis via methods such as seeking second opinions, consulting specialists, getting further medical tests, and researching information about the medical condition.

Misdiagnosis can and does occur and is reasonably common with error rates ranging from 1.4% in cancer biopsies to a high 20-40% misdiagnosis rate in emergency or ICU care. Surveys of patients also indicate the chance of experiencing a misdiagnosis to range from 8% to 40%. This makes misdiagnosis one of the most common types of medical mistakes.

There are various reasons as to why a misdiagnosis can occur including errors by doctors, specialists, and laboratory tests. The patient can also contribute to an error in various ways.

There are various types of misdiagnosis ranging from a totally wrong diagnosis to a partial misdiagnosis as to the wrong subtype, underlying condition, medication causes, related conditions, or complications. Conditions for which a person never seeks medical advice are also a common type of misdiagnosis.

Misdiagnosis does not occur equally for all conditions but follows certain patterns. Some conditions are inherently more difficult to diagnose, whereas common familiar conditions are less commonly misdiagnosed. Some diseases are over-diagnosed whereas other conditions are more commonly under-diagnosed or overlooked.

Misdiagnosis need not be a feared outcome. There are various ways to prevent a misdiagnosis such as seeking a second opinion or a specialist referral. Getting educated about the possible alternative or underlying diagnoses for a condition is useful information to discuss with your doctor.

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What is cancer of the small intestine?

Cancer of the small intestine, a rare cancer, is a disease in which cancer (malignant) cells are found in the tissues of the small intestine. The small intestine is a long tube that folds many times to fit inside the abdomen. It connects the stomach to the large intestine (bowel). In the small intestine, food is broken down to remove vitamins, minerals, proteins, carbohydrates, and fats.

A doctor should be seen if there are any of the following:

—      Pain or cramps in the middle of the abdomen.

—      Weight loss without dieting.

—      A lump in the abdomen.

—      Blood in the stool.

If there are symptoms, a doctor will usually order an upper gastrointestinal x-ray (also called an upper GI series). For this examination, a patient drinks a liquid containing barium, which makes the stomach and intestine easier to see in the x-ray. This test is usually performed in a doctor’s office or in a hospital radiology department.

The doctor may also do a CT scan, a special x-ray that uses a computer to make a picture of the inside of the abdomen. An ultrasound, which uses sound waves to find tumors, or an MRI scan, which uses magnetic waves to make a picture of the abdomen, may also be done.

The doctor may put a thin lighted tube called an endoscope down the throat, through the stomach, and into the first part of the small intestine. The doctor may cut out a small piece of tissue during the endoscopy. This is called a biopsy. The tissue is then looked at under a microscope to see if it contains cancer cells.

The chance of recovery (prognosis) depends on the type of cancer, whether it is just in the small intestine or has spread to other tissues, and the patient’s overall health.

Stage Explanation

Stages of cancer of the small intestine

Once small intestine cancer is found, more tests will be done to find out if cancer cells have spread to other parts of the body. Although there is a staging system for cancer of the small intestine, for treatment purposes this cancer is grouped based on what kind of cells are found. The types of cancer found in the small intestine include adenocarcinoma, sarcoma, and carcinoid tumors. (Refer to the PDQ summary on Gastrointestinal Carcinoid Tumor Treatment for more information on carcinoid tumors. Refer to the PDQ summaries on Adult Soft Tissue Sarcoma Treatment and Childhood Soft Tissue Sarcoma Treatment for more information on sarcomas.) (For information on small intestine lymphoma, refer to the PDQ summaries on Adult Non-Hodgkin’s Lymphoma and Childhood Non-Hodgkin’s Lymphoma Treatment.)

Adenocarcinoma

Adenocarcinoma starts in the lining of the small intestine and is the most common type of cancer of the small intestine. These tumors occur most often in the part of the small intestine nearest the stomach. These cancers often grow and block the bowel.

Leiomyosarcoma

Leiomyosarcomas are cancers that start growing in the smooth muscle lining of the small intestine.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the small intestine or in another part of the body.

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The phrase “signs of Small intestine cancer, adult” should, strictly speaking, refer only to those signs and symptoms of Small intestine cancer, adult that are not readily apparent to the patient. The word “symptoms of Small intestine cancer, adult” is the more general meaning; see symptoms of Small intestine cancer, adult.

The signs and symptom information on this page attempts to provide a list of some possible signs and symptoms of Small intestine cancer, adult. This medical information about signs and symptoms for Small intestine cancer, adult has been gathered from various sources, may not be fully accurate, and may not be the full list of Small intestine cancer, adult signs or Small intestine cancer, adult symptoms. Furthermore, signs and symptoms of Small intestine cancer, adult may vary on an individual basis for each patient. Only your doctor can provide adequate diagnosis of any signs or symptoms and whether they are indeed Small intestine cancer, adult symptoms.

Symptoms:

The list of medical symptoms mentioned in various sources for Small intestine cancer, adult includes those listed below. Note that Small intestine cancer, adult symptoms usually refers to various medical symptoms known to a patient, but the phrase Small intestine cancer, adult signs may often refer to those signs that are only noticable by a doctor:

—      Asymptomatic in early stages

—      Abdominal pain

—      Abdominal cramps

—      Weight loss

—      Abdominal mass

—      Blood in stool

—      Fatigue

—      Black stool

—      Pallor

—      Gastrointestinal bleeding

—      Anemia

—      Vomiting

More detailed symptom information may be found on the symptoms of Small intestine cancer, adult article. In addition to the above medical information, to get a full picture of the possible signs or symptoms of this condition and also possibly the signs and symptoms of its related medical conditions, it may be necessary to examine symptoms that may be caused by complications of Small intestine cancer, adult, underlying causes of Small intestine cancer, adult, associated conditions for Small intestine cancer, adult, risk factors for Small intestine cancer, adult, or other related conditions.

These general reference articles may be related to medical signs and symptoms of disease in general:

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The small intestine is the longest section of the digestive tube and consists of three segments forming a passage from the pylorus to the large intestine:

—      Duodenum: a short section that receives secretions from the pancreas and liver via the pancreatic and common bile ducts.

—      Jejunum: considered to be roughly 40% of the small gut in man, but closer to 90% in animals.

—      Ileum empties into the large intestine; considered to be about 60% of the intestine in man, but veterinary anatomists usually refer to it as being only the short terminal section of the small intestine.

In most animals, the length of the small intestine is roughly 3.5 times body length - your small intestine, or that of a large dog, is about 6 meters in length. Although precise boundaries between these three segments of bowel are not observed grossly or microscopically, there are histologic differences among duodenum, jejunum and ileum.

A bulk of the small intestine is suspended from the body wall by an extension of the peritoneum called the mesentery. As seen in the image to the right, blood vessels to and from the intestine lie between the two sheets of the mesentery. Lymphatic vessels are also present, but are not easy to discern grossly in normal specimens.

It is within the small intestine that the final stages of enzymatic digestion occur, liberating small molecules capable of being absorbed. The small intestine is also the sole site in the digestive tube for absorption of amino acids and monosaccharides. Most lipids are also absorbed in this organ. All of this absorption and much of the enzymatic digestion takes place on the surface of small intestinal epithelial cells, and to accomodate these processes, a huge mucosal surface area is required.

If the small intestine is viewed as a simple pipe, its lumenal surface area would be on the order of one half of a square meter. But in reality, the absorptive surface area of the small intestine is roughly 250 square meters - the size of a tennis court! How is this possible? At first glance, the structure of the small intestine is similar to other regions of the digestive tube, but the small intestine incorporates three features which account for its huge absorptive surface area:

—      Mucosal folds: the inner surface of the small intestine is not flat, but thrown into circular folds, which not only increase surface area, but aid in mixing the ingesta by acting as baffles.

—      Villi: the mucosa forms multitudes of projections which protrude into the lumen and are covered with epithelial cells.

—      Microvilli: the lumenal plasma membrane of absorptive epithelial cells is studded with densely-packed microvilli.

The panels below depict the bulk of this surface area expansion, showing villi, epithelial cells that cover the villi and the microvilli of the epithelial cells. Note in the middle panel, a light micrograph, that the microvilli are visible and look something like a brush. For this reason, the microvillus border of intestinal epithelial cells is referred to as the “brush border”.

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Depending on the histology, cancer of the small intestine is treatable and sometimes curable. Adenocarcinoma, lymphoma, sarcoma, and carcinoid tumors account for the majority of small intestine malignancies which, as a whole, account for only 1%-2% of all gastrointestinal malignancies.[1-4] As in other gastrointestinal malignancies, the predominant modality of treatment is surgery when resection is possible, and cure relates to the ability to completely resect the cancer. The overall 5-year survival rate for resectable adenocarcinoma is only 20%. The 5-year survival rate for resectable leiomyosarcoma, the most common primary sarcoma of the small intestine, is approximately 50%. Carcinoid tumors of the small intestine are covered elsewhere as a separate cancer entity; for information see the PDQ summary on gastrointestinal carcinoid tumor. Lymphoma of the small intestine is dealt with briefly here; for more detailed information, a separate summary containing information on non-Hodgkin’s lymphoma is also available in PDQ.

References:

1.Coit DG: Cancer of the small intestine. In: DeVita VT, Hellman S, Rosenberg SA, Eds.: Cancer: Principles and Practice of Oncology. Philadelphia: JB Lippincott Company, 4th Edition, 1993, pp 915-928.

2.Serour F, Dona G, Birkenfeld S, et al.: Primary neoplasms of the small bowel. Journal of Surgical Oncology 49(1): 29-34, 1992.

3.Matsuo S, Eto T, Tsunoda T, et al.: Small bowel tumors: an analysis of tumor-like lesions, benign and malignant neoplasms. European Journal of Surgical Oncology 20(1): 47-51, 1994.

4.Chow JS, Chen CC, Ahsan H, et al.: A population-based study of the incidence of malignant small bowel tumours: SEER, 1973-1990. International Journal of Epidemiology 25(4): 722-728, 1996.

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The small intestine or bowel is part of the digestive tract. It is a long tube (about 30 ft.) that runs from the duodenum (at the outlet from the stomach) to the large intestine. In order to fit into the abdomen, it is wound back and forth within the abdominal cavity. It is where most of the nutrients and water are extracted from food before waste products are excreted. It also separates the digestive bacteria from the bloodstream while being able to pass nutrients to the blood.

There are several diseases, such as colitis, Crohn’s disease and irritable bowel syndrome that affect the small intestine. Moreover, any perforation in the bowel will leak contents into the abdominal cavity, causing peritonitis, or the bloodstream, most likely leading to sepsis. Most gunshot victims die from bacteria released by the perforated bowel rather than from any trauma caused by the wound.

The bowel can also suffer blockage, which can be life threatening. Luckily, a large portion of the bowel can be removed and the remaining ends sutured together with very little effect on the patient

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The part of the gastrointestinal tract (GI tract) that extends from the pyloric sphincter to the ileocecal valve, where it empties into the large intestine. The small intestine finishes the process of digestion, absorbs the nutrients, and passes the residue on to the large intestine. The liver, gallbladder, and pancreas are accessory organs of the digestive system that are closely associated with the small intestine.

The small intestine is divided into the duodenum, jejunum, and ileum. The small intestine follows the general structure of the GI tract in that the wall has a mucosa with simple columnar epithelium, submucosa, smooth muscle with inner circular and outer longitudinal layers, and serosa. The absorptive surface area of the small intestine is increased by plicae circulares, villi, and microvilli.

Exocrine cells in the mucosa of the small intestine secrete mucus, peptidase, sucrase, maltase, lactase, lipase, and enterokinase. Endocrine cells secrete cholecystokinin and secretin.

The most important factor for regulating secretions in the small intestine is the presence of chyme. This is largely a local reflex action in response to chemical and mechanical irritation from the chyme and in response to distention of the intestinal wall. This is a direct reflex action, thus the greater the amount of chyme, the greater the secretion.

Size, location, and structure of the small intestine

—      2.5cm wide and 6m long

—      Fills most of the abdomen

—      Begins at the pyloric sphincter and and ends with its connection to the large intestine at the ileocaecal valve

—      3 parts:

—      duodenum

—      jejunum

—      ileum

Function of the small intestine

—      Forward propulsion of contents

—      Major site of digestion

—      90% absorption

—      Protection against infection

—      Hormone secretion

—      Intestinal juice secretion

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According to the results of a study published in the journal Gut, the lifetime risk of small intestine cancer among individuals with Lynch Syndrome is roughly 4%.

Lynch Syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), results from inherited mutations in genes involved in DNA mismatch repair. These mutations greatly increase the risk of developing colorectal cancer, and also increase the risk of several other cancers, such as cancers of the endometrium (the lining of the uterus), ovary, small intestine, ureter, and renal pelvis. 

The small intestine is the part of the digestive system that extends from the stomach to the large intestine. Cancer of the small intestine is relatively rare in the general population. There will be an estimated 5,640 new cases in the U.S. in 2007.

To evaluate the lifetime risk of small intestine cancer among those with Lynch Syndrome, researchers in the Netherlands conducted a study among 1,496 individuals with a mismatch repair gene mutation. These individuals came from 189 different families.

—      28 cases of small intestine cancer were identified. Age at diagnosis of small intestine cancer ranged from 23 to 69 years, with a median age at diagnosis of 52 years.

—      The lifetime risk of developing small intestine cancer was 4.2%. Risk was similar among men and women and did not vary significantly by history of colorectal cancer or family history of small intestine cancer.

—      Information about presenting symptoms was available for 16 of the 28 patients with small intestine cancer. In nine cases, the patient presented with unexplained anemia. Six patients presented with small bowel obstruction and five patients reported abdominal pain. Jaundice, gastrointestinal bleeding, and weight loss were each reported by one patient.

This study suggests that roughly one out of 25 individuals with Lynch Syndrome will develop small intestine cancer during their lifetime. The researchers conclude that this risk may be too low to warrant routine use of invasive screening tests for small intestine cancer, such as double balloon enteroscopy.

Because the risk of small intestine cancer is higher among individuals with Lynch Syndrome than among the general population, however, the researchers note that small intestine cancer should be considered among individuals with Lynch Syndrome who experience unexplained abdominal complaints and/or unexplained iron-deficiency anemia.

References:

National Cancer Institute. Genetics of Colorectal Cancer (PDQ®). Health Professional Version. (Accessed September 19, 2007).

American Cancer Society. Cancer Fact & Figures 2007. Available at: (Accessed September 19, 2007).

Ten Kate GL, Kleibeuker JH, Nagengast FM et al. Is surveillance of the small bowel indicated for Lynch Syndrome families. Gut. 2007;56:1198-1201.

Related News:  (9/27/2006)

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