Intestinal Cancer Introduction This reference summary discusses cancer of the small intestines, not cancer of the colon. Intestinal cancer starts in the cells of the small intestine. The small intestine connects the stomach to the large intestine. Intestinal cancer is rare. But eating a high-fat diet or having certain digestive diseases can raise a person s risk. This reference summary will help you better understand what intestinal cancer is and what treatment options are available. The Digestive Tract The digestive tract is made up of organs through which food and liquids pass. The small intestine is part of the digestive tract. This section reviews anatomy that is important in understanding intestinal cancer. Swallowed food goes through the esophagus, which is the feeding tube. Next, food passes through the stomach, where it is partially digested. Digested food goes from the stomach to the small intestine. The small intestine is the longest part of your digestive system. It is where most nutrients are further digested and absorbed into the body. The small intestine has three areas: Duodenum. Jejunum. Ileum. Esophagus Duodenum Jejunum Ileum Stomach Colon 1
Fibers and digested food finally reach the colon. In the colon, the rest of the nutrients get absorbed and stools are formed. Stools are also known as feces, or poop. Stools are stored in the last part of the colon before being excreted. This part of the colon is made up of the sigmoid colon and rectum. Stool leaves the body through the anus. The inside wall of the small intestines is called the mucosa. The mucosa of the small intestine contains many folds. The folds are covered with tiny, finger-like growths called villi. The villi allow the small intestine to absorb nutrients. Intestinal Cancer The body is made up of very small cells. Normal cells in the body grow and die in a controlled way. Sometimes cells keep dividing and growing in an uncontrolled way. This causes an abnormal growth called a tumor. If the tumor does not invade nearby tissues and body parts, it is called a benign tumor. A benign tumor is a non-cancerous growth. Benign tumors are usually not life threatening. If the tumor invades nearby tissues and body parts, it is called a malignant tumor, or cancer. Cancer cells spread to different parts of the body through blood vessels and lymph channels. Lymph is a clear fluid produced by the body that drains waste from cells. It travels through special vessels and bean-shaped structures called lymph nodes. Cancer that moves from one tissue to other body parts is known as metastatic cancer. For instance, an intestinal tumor may grow through the small intestine s outer layer and to nearby tissues over time. Cancers in the body are given names, depending on where the cancer started. Cancer that begins in the small intestine will always be called intestinal cancer, even if it spreads to other places. There are many different types of intestinal cancer. This program focuses on the two most common types: adenocarcinoma and leiomyosarcoma. The most common type of small intestine cancer is adenocarcinoma. This type starts in the cells that line the inside of the small intestine. Most of these tumors happen in the part of the small intestine near the stomach. They may grow and block the intestine. Adenocarcinoma 2
Leiomyosarcoma starts in the smooth muscle cells of the small intestine. Most of these tumors happen in the part of the small intestine near the large intestine. Risk Factors It is usually impossible to specify the cause of cancer in an individual patient. But we do know what causes cancer in general. Health care providers also know factors that can increase the chance of getting cancer. Leiomyosarcoma These are known as risk factors. Eating a high-fat diet raises the risk for intestinal cancer. Eating a high-fiber diet may lower the risk. Fiber helps to get rid of excess fat from the intestines. Having Crohn s disease also raises a person s risk. Crohn's disease causes inflammation of the digestive system. It can affect any area, from the mouth to the anus. It often affects the lower part of the small intestine. High-Fiber Diet High-Fat Diet Another risk factor for intestinal cancer is having celiac disease. In people with celiac disease, the immune system harms the small intestine when a person eats gluten. Gluten is a protein found in wheat, rye and barely. A history of colonic polyps raises the risk of intestinal cancer. A polyp is an extra piece of tissue that grows inside your body. Colonic polyps grow in the large intestine, or colon. Most are not dangerous, but they can turn into cancer. A person is also at risk for intestinal cancer if they have FAP. FAP stands for familial adenomatous polyposis. It is an inherited condition. FAP causes many polyps to grow on the inside walls of the colon and rectum. Symptoms Intestinal cancer may not cause any symptoms at first. Symptoms often start after the cancer has grown. 3
Common symptoms of intestinal cancer include: A lump in the abdomen. Abdominal pain. Black, tarry stool. Blood in the stool. Weakness and extreme tiredness. Weight loss for no reason. Abdominal pain is often the first symptom. Eating may cause the pain to start or to get worse. If a tumor blocks the intestines, it can cause severe pain. It may also cause severe nausea and vomiting. Rarely, intestinal cancer may cause a hole in the wall of the intestine. The partially digested food and other contents of the intestines can then leak into the abdomen. This can also cause severe pain, nausea and vomiting. But the symptoms often start very suddenly. These symptoms may not be caused by intestinal cancer. Make sure to see a health care provider to find out what is causing your symptoms. Diagnosis Your health care provider will ask about your personal and family medical history. A physical exam will be performed. You may also have blood tests or other lab tests to rule out other causes of your symptoms. A blood test can be used to measure how well the liver is working. If a certain substance in the blood is too high, it can be a sign of liver disease. Liver disease may be caused by small intestine cancer. Samples of stool, or poop, may also be collected for testing. A fecal occult blood test checks these samples for blood that can only be seen with a microscope. Imaging tests of the abdomen can be done to find tumors. These tests may include an abdominal x-ray, CT scan or MRI. A CT scan uses an x- ray machine linked to a computer. A CT scan takes a series of detailed pictures of your organs. You may be given contrast material by mouth or injection. This material will make abnormal areas easier to see. 4
An MRI uses strong magnets to create images of the inside of the body. You may receive contrast material by injection to make abnormal areas easier to see. A barium enema is a series of x-rays of the lower digestive tract. For this test, a liquid that contains barium is put into the rectum. The barium coats the lower digestive tract and makes it show up better on the x-rays. An upper GI series is also a series of x-rays, but these look at the esophagus, stomach and small intestine. For this test, the patient drinks a liquid that contains barium. An upper endoscopy can look at the inside of the esophagus, stomach and first part of the small intestine. This procedure uses a thin, lighted tube called an endoscope. It is inserted through the mouth, down the esophagus and to the small intestine. During an endoscopy, samples of tissue may be taken. This is called a biopsy. The samples are then viewed under a microscope to check for cancer cells. A lymph node biopsy may also be done. For this biopsy, part or all of a lymph node is removed and examined for cancer cells. Sometimes a surgery called a laparotomy is needed to diagnose intestinal cancer. This surgery involves an incision, or cut, in the wall of the abdomen. A biopsy may also be done during this surgery. A pathologist will then examine the biopsy sample under a microscope to look for cancer cells. A biopsy is the only sure way to know if cancer cells are present. Staging If you have intestinal cancer, your health care provider will determine the stage of the cancer. Staging is an attempt to find out if the cancer has spread and, if so, to which parts of the body. Staging is helpful in deciding the best course of treatment. Stages are usually described using the numbers 1-4; a lower number indicates an earlier stage. 5
Intestinal cancer is also described in groups. These groups depend on: How many layers of the intestinal wall the tumor has invaded. Whether or not the cancer has spread to nearby lymph nodes. Whether or not the cancer has spread to distant organs, such as the liver or lungs. Other health care providers may group intestinal cancer according to whether or not the tumor can be completely removed by surgery. Ask your health care provider about what stage of intestinal cancer you have and what that means. Treatment and Supportive Care The type of treatment used depends on the size and location of the tumor, the stage of the disease and the health of the patient. Treatment for intestinal cancer may include surgery, radiation therapy, chemotherapy or some combination of these treatments. Surgery is the most common treatment of intestinal cancer. It often involves removing part or all of the small intestine. Nearby organs may also be removed if they are affected. Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. The way the radiation therapy is given depends on the type and stage of the cancer being treated. Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be given in the blood stream through an IV or taken by mouth. It can also be placed in a specific area of the body. The type used depends on the type and stage of the cancer being treated. Radiation therapy and chemotherapy may sometimes be done together. These treatments may be used on their own, before surgery or after surgery. There may also be clinical trials available for people with intestinal cancer. Clinical trials test new medical approaches and treatments. 6
Cancer and its treatment can lead to other health problems. It is important to have supportive care before, during and after cancer treatment. Supportive care is treatment to control symptoms. The goal is to relieve the side effects of therapy and help you cope with emotions. Supportive care also deals with the pain associated with cancer and its treatments. Your health care provider or a pain control specialist can suggest ways to relieve or reduce pain. Summary Intestinal cancers are rare. These cancers begin in the small intestine, which connects the stomach to the large intestine. There are different types of intestinal cancers. The most common type is adenocarcinoma. This type starts in the cells lining the inside of the small intestine. Even though intestinal cancers are rare, eating a high-fat diet or having certain digestive problems can raise a person s risk. These problems include: A history of colonic polyps. Celiac disease. Crohn s disease. FAP. Treatments for intestinal cancer usually include surgery, radiation therapy or chemotherapy. Some combination of these treatments may also be used. Intestinal cancer is most treatable in its early stages. Research has already led to advances that have helped people live longer. It continues to find better ways to care for people with intestinal cancer. 7