Small Intestine Cancer

A risk factor includes anything that increases your chances of getting a disease. Having a risk factor doesn’t mean you’ll get cancer. Not having risk factors doesn’t mean you won’t get cancer.

Risk factors for small intestine cancer include:

• Age: Cancer risk for many types of small intestine tumors increases with age. The average age of diagnosis is 65.
• Sex: Small intestine cancer is slightly more common in males.
• Race: In the U.S., small intestine cancer is slightly more common among people who are Black. The exception is lymphoma, which is more common among people who are white.
• Inherited genetic conditions: Having a biological parent, sibling or child with certain conditions may increase your risk. These conditions include familial adenomatous polyposis (FAP), Peutz-Jeghers syndrome, hereditary nonpolyposis colorectal cancer (HNPCC) and Lynch syndrome.
• Inflammatory conditions: Diseases involving chronic inflammation affecting your bowels, like Crohn’s disease and celiac disease, may increase your risk.
• Autoimmune disorders or a weakened immune system: Conditions that weaken your immune system, like HIV/AIDS, Crohn’s disease and celiac disease, may increase your risk. Treatments like radiation therapy may weaken your immune system and make you more susceptible to small intestine cancer. Drugs that suppress your immune system following an organ transplant may also increase your risk.

Some studies have suggested that diet (eating salty or smoked foods and red meat), tobacco use and alcohol consumption may play a role in small intestine cancer risk.

Talk to your healthcare provider if you’re concerned you may be at risk for small intestine cancer.

How is small intestine cancer diagnosed?

Small intestine cancer can be challenging to diagnose because it’s so rare. Also, symptoms vary depending on the type of tumor. It may take extensive procedures and tests before you receive a diagnosis.

Physical exam and history

Your healthcare provider will examine you to check your general health and look for signs of disease. They’ll take a history of past illnesses and treatments and ask about your health habits.

Blood tests

• Blood chemistry studies: A test that measures the amounts of certain substances released into your blood by organs and tissues. An unusual (higher or lower than typical) amount of a substance can be a sign of disease in the organ or tissue that produces it. For instance, your healthcare provider may order a liver function test to check for signs that cancer has spread to your liver.
• Complete blood count (CBC): A test that gives your healthcare provider information about your blood cells. Small intestine tumors may cause bleeding that can reduce your red blood cell count and cause anemia.

Imaging

• Endoscopy: A procedure that uses a thin, tube-like instrument with a light and lens (endoscope) to look inside parts of your gastrointestinal (GI) tract. With an upper endoscopy, your healthcare provider inserts the endoscope into your mouth and uses it to examine your esophagus, stomach and the first part of your intestine near your stomach (duodenum). A double-balloon enteroscopy uses a special endoscope to see deeper inside of your small intestine. During an endoscopy, your healthcare provider may remove tissue samples (biopsy) that can be examined under a microscope for signs of disease.
• Capsule (pill) endoscopy: A procedure involving swallowing a capsule containing a tiny camera. As the capsule travels through your body, it takes pictures of your GI tract that can be downloaded to a computer for your healthcare provider to view. The name can be a bit confusing, but this procedure doesn’t involve using an endoscope.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside of your body, taken from different angles. A computer linked to an X-ray machine displays the images. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves and a computer to make a series of detailed pictures of areas inside of your body. An MRI and CT scan both provide similar information about how a tumor may be impacting soft tissue. Still, CT scans are used more often to diagnose small intestine cancer.
• Abdominal X-ray: An X-ray of the organs in your abdomen. An X-ray is an energy beam that can travel through your body and onto film, making a picture of areas inside of your body.
• Barium X-ray: A procedure that involves coating your GI tract with a chalky substance called barium. The barium makes it easier to see your GI tract on an X-ray. An upper GI series with a small bowel follow-through takes a series of X-rays as the barium travels through your GI tract (esophagus, stomach and small bowel). A lower GI series (barium enema) involves inserting a liquid with barium into your rectum. The barium coats the lower GI tract as X-rays are taken.

Surgery

Your healthcare provider may perform surgery if other tests don’t provide enough information for a diagnosis. These procedures allow your healthcare provider to assess your organs directly. They’ll perform a biopsy to examine any suspicious tissue for signs of cancer.

Procedures include:

• Laparoscopy: A surgical procedure in which a thin tube similar to a telescope (laparoscope) is inserted into your abdomen through a small incision (cut) or multiple small incisions. The laparoscope allows your healthcare provider to assess your abdominal organs for signs of cancer.
• Laparotomy: A surgical procedure in which an incision (cut) is made into your abdominal wall so your healthcare provider can check your abdominal organs for signs of cancer.

What are the stages of small intestine cancer?

Cancer staging can provide information on the size of a tumor, where it’s located and whether it’s spread (metastasized). Tests and procedures to stage small intestine cancer usually happen during diagnosis.

The type of small intestine cancer you have (carcinoid tumor, adenocarcinoma, sarcoma or lymphoma) will determine the staging system your healthcare provider uses.

What are the treatments for small intestine cancer?

The treatment you receive depends on the type of cancer you have, its stage, where the tumor is located and even the characteristics of the cells inside the tumor. Your preferences will also guide treatment decisions.

Surgery

Surgery is the most common treatment for small intestine cancer. Surgery may include:

• Resection: Surgery to remove all or part of an organ that contains cancer. Your healthcare provider may remove segments of your small intestine and nearby organs (if the cancer has spread). Afterward, they may perform an anastomosis (joining the cut ends of the intestine together). Your healthcare provider may remove lymph nodes near your small intestine to test them for signs of cancer spread.
• Bypass: Surgery to allow food in your small intestine to go around (bypass) a tumor blocking your intestine, but which can’t be removed.

Chemotherapy

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Depending on the chemotherapy treatment, the drugs may target cancer cells in a specific part of your body (regional chemotherapy) or destroy cancer cells throughout your body (systemic chemotherapy).

Your healthcare provider may prescribe chemotherapy after surgery to kill any remaining cancer cells (adjuvant therapy). You may receive systemic chemotherapy if your cancer has metastasized.

Radiation therapy

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. Your healthcare provider may recommend radiation if your cancer can’t be removed surgically. Radiation therapy may also be a part of palliative care to help with symptom relief. Sometimes, radiation is administered alongside chemotherapy (chemoradiation therapy) after surgery to kill any remaining cancer cells.

Somatostatin analogs

Your healthcare provider may recommend somatostatin analogs to treat carcinoid tumors of the small intestine. These medications stop your body from making too many hormones. In turn, they can ease symptoms and help control disease. Examples of somatostatin analogs include lanreotide and octreotide.

More research is needed to understand the benefits of using radiation with chemotherapy following surgery for small intestine cancer.

Targeted therapy

Targeted therapies identify weaknesses in cancer cells and use these weaknesses to destroy them. Researchers are currently studying targeted therapy treatments that may aid in treating adenocarcinomas, GIST and lymphomas.

Immunotherapy

Immunotherapy boosts your immune system so it’s better able to fight cancer cells. Your immune system naturally fights abnormal cells and dangerous bodily invaders like germs. Unfortunately, cancer cells can sometimes get past your immune system’s defenses. Immunotherapy makes it easier for your immune system to recognize cancer cells and destroy them.

Depending on the type of gene mutations in your tumor, your healthcare provider may recommend immunotherapy.

Clinical trials

Clinical trials are studies used to determine if new cancer treatments are safe and effective or better than standard treatments. Currently, treatments involving adjuvant chemotherapy, targeted therapy and immunotherapy, and others are being researched in clinical trials. Ask your healthcare provider if you’re a strong candidate for a clinical trial.

To reduce your risk of cholangiocarcinoma, you can:

• Stop smoking. Smoking is linked to an increased risk of cholangiocarcinoma. If you smoke, stop. If you have tried quitting in the past and haven’t been successful, talk with your doctor about strategies to help you quit.

• Reduce your risk of liver disease. Chronic liver disease is associated with an increased risk of cholangiocarcinoma. Some causes of liver disease can’t be prevented, but others can. Do what you can to take care of your liver.

  For instance, to reduce your risk of liver inflammation (cirrhosis), drink alcohol in moderation, if you choose to drink. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men. Maintain a healthy weight. When working with chemicals, follow the safety instructions.