Small intestine cancer (patient information)

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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor(s)-In-Chief: Jinhui Wu, M.D.

Overview
Small intestine cancer is a rare digestive tract cancer in the United States. It occurs in the small intestine which is responsible for digesting and absorbing the food you eat and then transporting the food debris to large intestine. Frequent symptoms are abdominal pain or lump, weight loss for no reason or blood in the stool. It can be diagnosed by image tests. Surgery is the most common treatment. Additional options include chemotherapy, radiation therapy or a combination.

What are the symptoms of small intestine cancer?
Early stomach cancer does not make any symptoms. When the cancer grows larger, people may notice one or more symptoms as the following:


 * abdominal discomfort or abdominal pain: It is relatively mild pain or no pain may be present with life-threatening condition. With the development of the cancer, abdominal pain may be persistent.
 * weight loss: This is because of the consumption of the cancer.
 * Weakness and fatigue: The reason is also because the cancer wastes your energy.

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that problems can be diagnosed and treated as early as possible.

Who is at risk for small intestine cancer?
There are some factors may increase the risk of acquiring small intestine cancer potentially. These risk factors are outlined in the table below:


 * Crohns disease: Crohns disease is a kind of immune system disease in small intestine. This disease can affect any part of the small intestine, especially in the ileum. Patients with this problem have a risk of 28 times higher than normal to develope cancer.
 * Celiac disease: This can also known as celiac sprue and gluten-sensitive enteropathy. As an immune system disease, the body makes antibodies that attack the lining of the intestines. Clinical survey show that patients with celiac disease have an increased risk of small intestine cancers.
 * Some inherited causes such as familial adenomatous polyposis (FAP), hereditary nonpolyposis colorectal cancer (HNPCC), Peutz-Jeghers syndrome (PJS) and cystic fibrosis (CF)
 * Smoking and alcohol abuse
 * Age: Small intestinal cancer becomes more common as people get older.
 * Gender: Men have higher risk than women to develope small intestine cancer.

How to know you have small intestine cancer?
It is hard to diagnose small intestine cancer in its early stages. Other problems can also cause the same symptoms such as stomach discomfort and other digestive system cancer. So, if you have those symptoms, you had better go to see your doctor to do some tests. They include lab tests, image tests and endoscopy.


 * Capsule endoscopy: In this procedure, the patient is not detected with an actual endoscope but with a capsule (about the size of a large vitamin pill) which contains a light source and a very small camera. After swallowed, the capsule goes through the small intestine for a period of 8 hours. It takes thousands of pictures which can be downloaded onto a computer for the doctor to analyze.
 * Double balloon enteroscopy and biopsy: This is a newer way of looking at the small intestine. At first the patient need to anesthesia. This technology makes the doctor to see the intestine a foot at a time and even take a biopsy if something abnormal.
 * Barium x-rays: This is an x-ray test that a person is given a medication that will temporarily slow bowel movement, so structures can be more easily seen on the x-rays. For this test, the patient drinks a millkshake-like substance called barium. X-ray method called fluroscopy tracks how the barium moves through your esophagus, stomach, and small intestine. Pictures are taken in a variety of positions. It includes upper GI series, enteroclysis and a barium enema.
 * Computed tomography (CT) scan: CT scans are often used to diagnose small intestine cancer. It can confirm the location of the cancer and show the organs near the small intestine, as well as lymph nodes and distant organs where the cancer might have spread. These are helpful in staging the cancer and in determining whether surgery is a good treatment option.

When to seek urgent medical care?
Call your health care provider if symptoms of small intestine cancer develop. If one emerges the following symptoms, seeking urgent medical care as soon as possible:


 * Severe abdominal pain: The reason of a person with small intestine cancer appears severe abdominal pain is sometimes because of samll intestine wall perforation or obstruction of small intestine canal . This is the results of cancer development. A surgery will be done urgently.

Treatment options
Patients with small intestine cancer have many treatment options. The selection depends on the the size and location of the tumor, whether it has spread to distance, whether there are any other serious medical conditions. The options are surgery, radiation therapy, chemotherapy, or a combination of methods and palliative treatment. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effect may not be the same for each person, and they may change from one treatment session to the next.

Surgery
 * Small intestine resection: In this operation, surgeon removes the piece of intestine that has the tumor and some of the normal tissue on each side of the tumor.
 * Palliative operation: If small intestine cancer has spread too far in the abdomen, the surgeon will do a palliative operation. The goal of this type of surgery is to decrease symptoms such as abdominal pain and abdominal distension.

Chemotherapy: The treatment is to use drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. Some general chemotherapy drugs used include: 5-fluorouracil (5FU), leucovorin, oxaliplatin, and irinotecan.

Radiation therapy: This is a cancer treatment to kill cancer cells or keep them from growing by using high-energy x-rays or other types of radiation.

Diseases with similar symptoms
Symptoms of abdominal and whole body have no specificity. Other health problems may also cause similar symptoms. Go to see your doctor to verify your diseases as early as possible. Diseases with similar symptoms are listed in the following:


 * Crohn's disease
 * Intestinal tuberculosis
 * Ulcerative colitis
 * Large intestine cancer
 * Irritable bowel syndrome (IBS)
 * Depression

Where to find medical care for small intestine cancer?
Directions to Hospitals Treating small intestine cancer

Prevention of small intestine cancer
Epidemiology data show the following intervention may help to reduce your risk of small intestine cancer:


 * Treatment celiac disease ,Crohns disease and inherited causes early
 * Quitting smoking and alcohol abuse

What to expect (Outook/Prognosis)?
The prognosis of small intestine cancer depends on the following:


 * Whether or not the tumor can be removed by surgery.
 * The stage of the cancer: the size of the tumor, whether the cancer has spread outside the small intestine
 * The patient’s general health
 * Whether the cancer has just been diagnosed or has recurred