Small Bowel Cancer

A capsule endoscopy is a common way to look inside the small intestine. This long, coiled tube is part of your digestive system, connecting your stomach to your large intestine. It's divided into three parts: the duodenum, jejunum, and ileum.

Small bowel cancer is a type of cancer that begins as an abnormal growth of cells inside the small intestine. Think of it as a tumor starting in this crucial part of your digestive tract.

The small intestine is important for digesting and absorbing nutrients from the food you eat. It's like a factory, breaking down food into its building blocks and sending them into your bloodstream. It also makes hormones that help with digestion. Crucially, the small intestine also plays a role in your body's immune system. It has cells that fight off bacteria and viruses that might enter your body through your mouth.

Treatment for small bowel cancer usually involves surgery to remove the cancerous growth. Doctors may also use chemotherapy, which uses medicines to kill cancer cells throughout the body. Targeted therapy is another approach, using medicines that specifically attack cancer cells. Radiation therapy might be used to shrink the tumor before surgery, making it easier to remove.

Small bowel cancer can cause several noticeable symptoms. These include:

• Belly pain: This pain might be a constant ache or come and go.
• Yellowing of the skin and eyes (jaundice): This happens when the body has trouble processing bilirubin, a substance made during the breakdown of old red blood cells. The yellowing is a sign of a possible blockage in the liver or bile ducts.
• Extreme tiredness or weakness: Feeling constantly drained, even after getting enough sleep, can be a symptom of many things, including cancer.
• Nausea and vomiting: These are common symptoms that can make you feel very unwell.
• Unintentional weight loss: Losing weight without trying to diet or exercise is a warning sign that something might be wrong. This could be due to the body using up energy to fight the disease.
• Blood in your stool: Blood in your stool can be a sign of bleeding somewhere in your digestive tract. This blood might look red (bright red or maroon) or black (tarry).
• Watery diarrhea: Frequent, loose, watery stools can be a symptom of many things, including small bowel cancer.
• Skin flushing: This is when your skin turns red or flushed. It can be a sign of various health problems, including some cancers.

If you're experiencing any of these symptoms, it's important to talk to your doctor. Early detection and treatment are key to managing and potentially curing many diseases, including cancer. Your doctor can help determine the cause of your symptoms and recommend appropriate next steps. Seeking a second opinion can provide additional perspectives and reassurance.

Small bowel cancer's exact cause is unknown. We do know that something goes wrong with the cells in the small intestine, causing them to become cancerous.

This happens because of changes in the DNA of the cells. DNA is like a set of instructions telling cells what to do. These changes tell the cells to grow and multiply much faster than normal. Usually, cells have a natural life cycle where they die off. But with cancer cells, they keep living, leading to an overgrowth of cells. This buildup can form a mass called a tumor. These abnormal cells can invade and damage surrounding healthy tissue. Over time, some of these cells can break off and spread to other parts of the body.

Different types of small bowel cancer arise from different types of cells. Understanding the type of cancer is important for treatment. Here are some common types:

• Adenocarcinoma: This is the most frequent type. It starts in the gland cells that produce mucus in the small intestine.

• Neuroendocrine tumors: These cancers begin in neuroendocrine cells. These cells are found throughout the body and have roles in both the nervous system and hormone production.

• Lymphoma: This cancer starts in the cells of the immune system. The immune system fights off infections. Cells in the small intestine's immune system battle bacteria and viruses that enter through the digestive tract. Most lymphomas in the small intestine are a kind called non-Hodgkin's lymphoma.

• Soft tissue sarcoma: This cancer starts in the connective tissues of the body. One example is gastrointestinal stromal tumor (GIST). GIST starts in special nerve cells located in the wall of the small intestine.

Doctors consider the specific type of small bowel cancer when creating a treatment plan. This helps them choose the best course of action for each individual patient.

Certain factors can make small bowel cancer more likely. Understanding these factors can help people take steps to lower their risk.

Family History: Sometimes, changes in your DNA, passed down from your parents, can raise your risk of small bowel cancer, as well as other cancers. Conditions like Lynch syndrome, familial adenomatous polyposis (FAP), and Peutz-Jeghers syndrome are examples of these inherited DNA problems. These inherited conditions can make your body more prone to developing abnormal cells that can lead to cancer.

Existing Bowel Conditions: If you have diseases that affect your intestines, like Crohn's disease, inflammatory bowel disease (IBD), or celiac disease, your risk of small bowel cancer may be higher. These conditions can cause long-term inflammation and damage to the intestinal lining, which can create a more favorable environment for abnormal cells to develop.

Weakened Immune System: A weakened immune system, the body's defense against germs, can also increase the risk of small bowel cancer. People with weakened immune systems, such as those with HIV infection or those taking medication to suppress their immune system after an organ transplant, have a higher risk of developing the disease. A strong immune system helps fight off abnormal cell growth, and a weakened system makes it harder to control this process.

Diet and Lifestyle: Studies suggest a link between certain dietary habits and a higher risk of small bowel cancer. Alcohol consumption, a diet low in fiber, and high in red meat, sugar, and salt-cured or smoked foods seem to be associated with increased risk. A healthy diet rich in fiber and avoiding excessive alcohol can help lower this risk. A balanced diet is key to overall health, including preventing cancer.

Small bowel cancer can lead to several problems:

• Higher chance of other cancers: People with small bowel cancer are more likely to develop other cancers. This includes cancers in the colon, rectum, ovaries, and the lining of the uterus (endometrium). Essentially, having one type of cancer can increase the risk of getting another.

• Spread to other organs: As small bowel cancer progresses, it can spread to other parts of the body. When cancer does this, it's called metastasis. A common place for small bowel cancer to spread is the liver. This means cancer cells from the small bowel travel to and grow within the liver.

Preventing small bowel cancer is still a bit of a mystery. However, there are things you can do to lower your overall cancer risk, and these may also help with small bowel cancer.

Eat a Balanced Diet: Filling your plate with a wide variety of fruits, vegetables, and whole grains is a good start. These foods are packed with vitamins, minerals, fiber, and antioxidants. Fiber helps your digestive system work better, and antioxidants can help protect your cells from damage. Think colorful fruits and vegetables – the different colors mean different vitamins and nutrients!

Limit Alcohol: If you drink alcohol, do so in moderation. For women, this means no more than one drink per day. For men, it's no more than two drinks per day. A drink is usually a standard glass of wine, a beer, or a shot of liquor.

Quit Smoking: Smoking significantly increases your risk of many cancers. If you smoke, quitting is one of the best things you can do for your health. Talk to your doctor or a healthcare professional about quitting smoking. There are programs and resources to help you succeed.

Be Active: Aim for at least 30 minutes of moderate-intensity exercise most days of the week. This could be brisk walking, swimming, cycling, or any activity that gets your heart rate up. If you're not used to being active, start slowly and gradually increase the amount and intensity of your workouts. It's always a good idea to talk to your doctor before starting a new exercise routine, especially if you have any health concerns.

Maintain a Healthy Weight: A healthy weight is important for overall health. If you're at a healthy weight, focus on maintaining it through a balanced diet and regular exercise. If you need to lose weight, consult with your doctor or a registered dietitian. They can help you create a safe and effective plan. Losing weight gradually, by combining exercise and a reduced calorie intake, is the healthiest way to do it.

Diagnosing small bowel cancer can be challenging. Because of this, people suspected of having this type of cancer often need several tests to find the cancer or rule out the possibility. These tests can help pinpoint the problem and determine the best course of treatment.

Finding Clues About Small Bowel Cancer

Different tests help doctors look for signs of small bowel cancer and understand its extent.

• Blood Tests: These tests can't directly detect small bowel cancer, but they can provide important information about your overall health. A complete blood count (CBC), for example, can reveal a low red blood cell count. A low red blood cell count might indicate bleeding, a possible symptom of cancer. Blood tests can also show how well your organs (like the kidneys and liver) are functioning. This is important because cancer can sometimes spread to these organs.

• Imaging Tests: These tests create pictures of the inside of your body. Different types of imaging can be used to pinpoint the location, size, and extent of the cancer. Examples include MRI (magnetic resonance imaging), CT (computed tomography) scans, and PET (positron emission tomography) scans.

• Biopsies: A biopsy is a procedure where a small tissue sample is removed for testing in a lab. This tissue can be collected during a procedure to examine the small intestine directly. Special tools are used to take the sample. Sometimes, surgery is needed to get the tissue sample. The lab analysis will determine if the tissue is cancerous and, if so, provide details about the cancer cells. This information is critical for creating a treatment plan.

• Tests to Examine the Small Intestine: Several tests allow doctors to see inside the small intestine. A tissue sample is often collected during these procedures to help with diagnosis. The specific test used depends on where the suspected cancer is located in the small intestine.

  • Upper Endoscopy: This procedure uses a thin, flexible tube with a camera (endoscope) to look at the esophagus, stomach, and the first part of the small intestine. Tools can be passed through the endoscope to collect a tissue sample.
  • Capsule Endoscopy (Pill Camera): A small, camera-equipped capsule is swallowed. The capsule takes pictures as it travels through the digestive system and then passes out of the body naturally. While this test can identify potential problems, it can't collect tissue samples. If something unusual is seen, additional tests will be needed to determine the nature of the issue.
  • Enteroscopy: This test uses specialized equipment to guide an endoscope further into the small intestine than a standard upper endoscopy. It allows a broader view, and a tissue sample can be collected. The enteroscopy procedure can be performed by passing the scope through the mouth or through the rectum and colon, depending on the location of the suspected cancer. Sedation (medicine to make you sleep) may be needed.

• Surgery: If other tests can't clearly identify the cancer or its extent, surgery might be necessary. This allows doctors to directly examine the small intestine and surrounding tissues. Surgery can involve a large incision (laparotomy) or multiple small incisions (laparoscopy). During laparoscopy, a surgeon uses specialized tools and a camera to guide the procedure and collect tissue samples. Sometimes, the cancer can be removed during surgery.

Getting the Right Care

A team of experienced medical professionals at Mayo Clinic can provide comprehensive care and support throughout your small bowel cancer journey. They can help you understand the tests, the diagnosis, and the treatment options available to you. Don't hesitate to reach out for support.

Treating Small Bowel Cancer

Small bowel cancer is treated mainly by surgery to remove the cancerous part of the intestine. Other common treatments are chemotherapy, radiation therapy, targeted therapy, and immunotherapy. The best treatment plan depends on where the cancer is located, the type of cancer, your overall health, and your preferences.

Surgery:

Surgeons try to remove all the cancerous tissue. If only a small portion of the small intestine is affected, the surgeon might just remove that section and rejoin the healthy parts. Sometimes, the entire small intestine needs to be removed. Surgeons also often remove the lymph nodes around the cancer to check for spread. If the cancer can't be fully removed, a bypass surgery might be done to relieve any blockages.

Chemotherapy:

Chemotherapy uses powerful drugs to kill cancer cells. These drugs usually work by targeting fast-growing cells, including cancer cells. Chemotherapy is often given through a vein, but some drugs can be taken as pills. After surgery, chemotherapy might be used to reduce the risk of the cancer returning. For advanced cancer, chemotherapy might help ease symptoms. In some cases, chemotherapy is used first to shrink the tumor before surgery if it's too large to be removed directly.

Radiation Therapy:

Radiation therapy uses high-energy beams, like X-rays, to destroy cancer cells. A machine directs the beams to the precise area of the cancer. Sometimes, radiation is used in combination with chemotherapy before surgery to make the tumor smaller.

Targeted Therapy:

Targeted therapy uses drugs that specifically attack certain parts of cancer cells. By targeting these parts, the drugs can help kill the cancer cells. Targeted therapy may be an option if surgery isn't possible or if the cancer has spread to other parts of the body.

Immunotherapy:

Immunotherapy helps the body's immune system fight the cancer. The immune system normally fights off diseases by attacking harmful cells. Cancer cells can sometimes hide from the immune system. Immunotherapy helps the immune system recognize and destroy the cancer cells. This treatment might be considered for advanced small bowel cancer if tests suggest it could be effective.

Coping with a Small Bowel Cancer Diagnosis:

Dealing with a cancer diagnosis can be challenging. It's important to:

• Learn as much as possible: Talk to your medical team about your cancer, test results, treatment options, and your prognosis. Understanding your situation will help you make informed decisions.
• Maintain strong relationships: Your friends and family can provide practical and emotional support. They can help with daily tasks, and offer a listening ear during difficult times.
• Seek support: Finding someone to talk to about your fears and hopes is crucial. This could be a friend, family member, counselor, medical social worker, clergy member, or a support group. Your medical team can provide information about support groups in your area. Helpful resources also include the National Cancer Institute and the American Cancer Society.

Dealing with a small bowel cancer diagnosis can be tough. It's a lot to take in, and feeling uncertain is normal. While you're figuring out how to cope, here are some things that might help:

Learn about your cancer: Understanding small bowel cancer will empower you to make decisions about your treatment. Talk to your doctors about everything: your test results, the different treatment options available, and what your outlook might be. The more you know, the more confident you'll feel about the choices you make.

Nurture your relationships: Strong friendships and family connections are crucial during this time. Your loved ones can provide practical help, like taking care of things at home while you're receiving treatment. They can also offer emotional support when you're feeling overwhelmed. Having someone to share your feelings and hopes with is extremely important.

Find a support system: Talking to someone about your worries and fears is vital. This could be a close friend, family member, or even a professional like a counselor, social worker, clergy member, or a member of a cancer support group. Your medical team can help you find support groups in your area. You can also get information from reputable organizations like the National Cancer Institute and the American Cancer Society.

In short: Learning about your cancer, staying connected with loved ones, and finding someone to talk to can all make a big difference as you navigate this challenging time. Remember, you're not alone.