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Small-Intestine Cancer

by Elliot M. Livstone, MD

  • Blood in the stool is a common symptom, but sometimes the cancer blocks the intestine, causing crampy abdominal pain and vomiting.

  • The diagnosis is based on various intestinal viewing techniques, including endoscopy and barium x-rays.

  • Surgical removal is the best form of treatment.

Cancerous (malignant) tumors in the small intestine are very uncommon, occurring in fewer than 9,000 people in the United States each year. Adenocarcinoma is the most common type of cancer of the small intestine. Adenocarcinomas develop in the glandular cells of the lining of the small intestine. People with Crohn disease of the small intestine are more likely than others to develop adenocarcinoma.

Symptoms and Diagnosis

Adenocarcinoma may cause bleeding into the intestine, which shows up as blood in the stool, and obstruction, which in turn may lead to crampy abdominal pain, expansion (distention) of the abdomen, and vomiting. Sometimes cancers of the small intestine cause intussusception (one segment of the intestine slides into another, much like the parts of a telescope).

Doctors typically do enteroclysis. In this procedure, a large amount of barium liquid is inserted through a tube in the nose and x-rays are taken as the barium moves through the digestive tract. Sometimes this procedure is done with a computed tomography (CT) scan instead of plain x-rays, in which case the person can just drink the barium rather than having a tube put through their nose. A doctor may use an endoscope (a flexible viewing tube) passed through the mouth and down to the duodenum and part of the jejunum (the upper and middle sections of the small intestine) to locate the tumor and perform a biopsy (remove a tissue sample for examination under a microscope). A doctor can sometimes see tumors of the ileum (the lower section of the small intestine) by passing a colonoscope (an endoscope used to view the lower part of the digestive tract) through the anus, through the entire large intestine, and up into the ileum. A wireless video capsule camera (see Video Capsule Endoscopy) can also be used to show tumors of the small intestine. Arteriography (an x-ray taken after a radiopaque dye is injected into an artery) of the intestinal arteries may be performed, especially if the tumor is bleeding. Similarly, radioactive technetium can be injected into the artery and observed on x-rays as it leaks into the intestine. This procedure helps locate sites where the tumor is bleeding. The bleeding can then be corrected surgically. Sometimes exploratory surgery is needed to identify a tumor in the small intestine.

Treatment

The best treatment for all types of cancerous growths is surgical removal of the tumor. If doctors are able to see the tumor with an endoscope, they may also remove it by applying an electrical current (electrocautery) or heat (thermal obliteration). Chemotherapy and radiation therapy after surgery do not lengthen survival time.

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