What is Small Bowel Cancer? What Are Its Symptoms? How Is It Diagnosed and Treated?

Small bowel cancer is a rare type of cancer. It occurs due to the abnormal proliferation of cells in the intestinal wall and may not be easily noticed in the early stages.

Symptoms often appear late, but you should be attentive if you experience complaints such as abdominal pain, loss of appetite, weight loss, nausea, and vomiting. Diagnosis may be delayed because these symptoms are often confused with other digestive system diseases. Small bowel hemorrhages account for approximately 5% of all digestive system hemorrhages.

In this article, you will find answers to questions about what small bowel cancer is, what its symptoms are, how it is diagnosed, and how it is treated. You will also learn about the four main types of small bowel cancer: adenocarcinoma, carcinoid tumor, lymphoma, and sarcoma.

What is small bowel cancer?

Small bowel cancer is a rare type of cancer that develops in the small intestine, which is an important part of the digestive system. This cancer occurs due to the abnormal proliferation of cells in the small intestinal wall and can significantly affect the digestive process.

Structure and function of the small intestine

The small intestine is a tube-shaped organ extending from the stomach to the large intestine. Being approximately 5-7 meters long, this organ constitutes the longest part of the digestive system. The small intestine consists of three main sections:

Duodenum: It is the section closest to the stomach, approximately 20-25 cm long, which surrounds the pancreas in a C-shape.

Jejunum: It is the middle section and is approximately 2.5 meters long.

Ileum: It is the final section and is approximately 3 meters long.

The primary task of the small intestine is the digestion and absorption of the food you eat. It also plays an important role in your immune system. Thanks to the special cells it contains, it fights against bacteria and viruses that enter your body. In addition, it produces hormones that aid digestion and ensures vitamin absorption.

The process of cancer development

Small bowel cancer usually begins with changes occurring in the DNA of healthy cells. Under normal conditions, cells grow and divide in an orderly manner according to the body's needs. However, when a cell's DNA is damaged, the cell continues to divide uncontrollably.

As a result of this uncontrolled division, the accumulated cells eventually form a tumor. Cancerous cells can grow, affect surrounding tissues, and spread to other parts of the body (metastasis).

Types of small bowel tumors

Small bowel cancer is seen in four main types:

Adenocarcinoma: It is the most common type of small bowel cancer. It usually develops in the duodenum region and begins in the cells lining the inner surface of the small intestine. As it grows, it can obstruct the intestine.

Carcinoid Tumor (Neuroendocrine Tumor): Developing in the neuroendocrine cells in the small intestine, these tumors begin in the cells that enable the body to produce hormones. They generally tend to grow slowly, and symptoms may not be seen for years.

Lymphoma: It begins in a type of white blood cell called a lymphocyte. These cells are an important part of your immune system. There are two main types: Hodgkin lymphoma and non-Hodgkin lymphoma.

Sarcoma: It develops in tissues such as muscle, connective tissue, or blood vessels. The most common subtype is the gastrointestinal stromal tumor (GIST).

Since each type develops differently, their effects on the body and treatment methods also vary. Small bowel cancer accounts for only 1-3% of all digestive tract cancers.

What are the symptoms of small bowel cancer?

Small bowel cancer, which progresses insidiously, usually does not show clear symptoms in the early stages. However, as the disease progresses, your body begins to send some signals. Being aware of these symptoms increases the possibility of early diagnosis and treatment.

Abdominal pain and digestive problems

One of the most common symptoms of small bowel cancer is abdominal pain. This pain is usually cramp-like and may worsen after meals. The pain is mostly felt in the stomach region and around the navel. In the advanced stages of the disease, the pain may also radiate to the back.

Digestive problems are also among the frequently seen symptoms. You may experience indigestion and difficulty in digestion. These problems usually arise as a result of the tumor narrowing the intestinal tract.

Loss of appetite and weight loss

Loss of appetite is a typical symptom of small bowel cancer. You begin to lose the desire for foods you normally enjoy eating. Loss of appetite leads to serious weight loss over time.

Weight loss usually occurs suddenly and in a short time. This situation arises as a result of loss of appetite caused by cancer, fatigue, or the inability to absorb nutrients sufficiently (malabsorption). Weight loss can also lead to a decrease in muscle mass.

Blood in the stool and anemia

Small bowel cancer tumors can cause bleeding, which leads to the appearance of blood in the stool. The blood can sometimes be bright red, while at other times it may appear dark brown. There may also be occult blood loss that is not visible to the naked eye in the stool.

Continuous blood loss causes anemia. Symptoms of anemia include fatigue, weakness, dizziness, and pale skin color. Especially if you have been experiencing unexplained fatigue for a long time, you should discuss this situation with your doctor.

Bloating, nausea, and vomiting

A feeling of bloating in the abdomen is another symptom of small bowel cancer. Bloating can occur due to obstruction or the inability to absorb nutrients sufficiently. If you notice a swelling or mass in the abdominal area that can be felt by hand, you should consult a healthcare professional immediately.

Nausea and vomiting are also frequently seen symptoms. These usually occur as a result of the tumor partially or completely obstructing the intestine. Nausea and vomiting may become more pronounced, especially after meals.

Changes in bowel habits

Small bowel cancer can cause changes in your normal bowel habits. You may experience diarrhea or constipation. While diarrhea is usually watery and fatty in consistency, constipation can be long-term and severe.

Intestinal obstructions can also be seen in the advanced stages of the disease. Some patients may apply to the hospital with complaints of sudden intestinal obstruction without showing any symptoms before. If you are experiencing recurrent episodes of intestinal obstruction, this situation must be investigated.

The presence of these symptoms does not definitively diagnose small bowel cancer, but it is an important reason to consult a doctor. The time elapsed from the onset of complaints to the diagnosis can vary between 3-16 months on average.

What causes small bowel cancer?

Scientists have not yet been able to determine exactly what causes small bowel cancer. However, some risk factors have been identified for this disease. These factors may increase a person's probability of having cancer.

Genetic factors

Genetic predisposition plays an important role in the development of small bowel cancer. If you have a family history of small bowel cancer or other digestive system cancers, your risk of developing this cancer may be higher. The increase in risk is more pronounced in individuals who have this type of cancer in their first-degree relatives.

Genetic factors also form the basis of some hereditary syndromes. In this case, mutations occurring in the DNA structure pave the way for uncontrolled cell division and tumor formation.

Hereditary syndromes

Some hereditary syndromes significantly increase the risk of small bowel cancer. These syndromes include:

Lynch syndrome (HNPCC): It is a hereditary disorder that increases the risk of many types of cancer, including small bowel cancer.

Familial Adenomatous Polyposis (FAP): It is a syndrome characterized by the formation of numerous polyps on the intestinal walls.

Peutz-Jeghers syndrome: It is a rare genetic disorder that causes polyp formation in the digestive system.

Li-Fraumeni syndrome and Gardner syndrome can also trigger the development of small bowel cancer.

It is recommended that individuals with these syndromes have regular screening tests. In addition, receiving genetic counseling services may also be beneficial.

Inflammatory bowel diseases

Bowel diseases that cause chronic inflammation can increase the risk of small bowel cancer. Especially Crohn's disease increases the risk of cancer by causing long-term inflammation in the small intestinal wall. In addition, other inflammatory bowel diseases such as ulcerative colitis are also among the risk factors.

These diseases lead to chronic damage on the inner surface of the intestines and can cause cells to proliferate abnormally over time. People with inflammatory bowel disease have a higher rate of developing colon cancer compared to other people.

Effects of nutrition and lifestyle

Unhealthy eating habits can increase the risk of small bowel cancer. Especially high-fat and low-fiber diets are among the risk factors. In addition, lack of physical activity and obesity can increase the risk of cancer.

Furthermore, celiac disease is also a risk factor for small bowel cancer. In celiac patients, abnormal cell growth and proliferation can be seen in the small intestine when they consume gluten.

Smoking, alcohol, and radiation exposure

Smoking and alcohol use are responsible for one-third of all cancers, not just small bowel cancer. The risk of cancer in people who smoke is higher than in those who do not. Similarly, excessive alcohol consumption can also cause changes in cells that can lead to cancer.

Especially in people who consume more than 4 glasses of alcohol per day and smoke 2 packs of cigarettes, the risk of digestive system cancers increases approximately 40 times. Radiation exposure can also increase the risk of small bowel cancer, especially after radiation treatments applied to the pelvic region.

Knowing the risk factors for small bowel cancer is important for early diagnosis and treatment. If you think you are in the risk group, it will be beneficial to have regular check-ups.

How is small bowel cancer diagnosed?

The diagnosis of small bowel cancer can be quite difficult because symptoms are often confused with other digestive system diseases. Your doctor may resort to various diagnostic methods by looking at your complaints and risk factors.

Physical examination and symptom evaluation

The diagnostic process usually begins with a comprehensive physical examination and evaluation of your symptoms. Your doctor will check for swelling or a mass by touching your abdominal area. They will also ask when your symptoms started, their severity, and frequency.

At this stage, if you have complaints such as long-standing abdominal pain, weight loss, or blood in the stool, you should definitely share them with your doctor. This information is very important in correctly directing the diagnostic process.

Endoscopy and colonoscopy

Endoscopic methods are used to see the inner wall of the small intestine. These include:

Gastroscopy: It allows the examination of the esophagus, stomach, and the beginning of the small intestine by entering through the mouth.

Enteroscopy: It images the deeper parts of the small intestines.

Double-balloon enteroscopy: It is used to examine a wider section of the small intestine.

In addition, capsule endoscopy is also a valuable diagnostic tool. In this method, a capsule containing a camera that you swallow takes numerous images as it passes through the digestive tract. Thus, your doctor can evaluate the inside of your small intestine.

Colonoscopy is performed with the help of a flexible tube inserted into the large intestine through the anus and is used to examine the large intestine and the final part of the small intestine.

Imaging methods (CT, MRI, PET)

Imaging tests are frequently used to detect abnormalities in the small intestine:

CT (Computed Tomography) scan creates detailed images of the abdomen and pelvic region. A special method called CT enterography uses contrast material to image the small intestines more clearly.

MRI (Magnetic Resonance Imaging) scan provides detailed images without using radiation. MR enterography is specifically designed for small bowel evaluation.

PET (Positron Emission Tomography) scan shows the metabolic activity of cancerous cells and is helpful in determining whether the disease has spread to other parts of the body.

In addition, methods such as barium radiography (passage graphy) can also be used in diagnosis.

Biopsy and laboratory tests

For a definitive diagnosis, the examination of a suspicious tissue sample (biopsy) is required. A biopsy is usually taken during endoscopy and examined in the pathology laboratory.

Blood tests also provide important information during the diagnostic process. A complete blood count is performed to detect the presence of anemia. In addition, stool tests are also used to determine whether there is occult bleeding.

Sometimes the diagnosis can also be made during emergency surgery performed due to intestinal obstruction or bleeding.

How is small bowel cancer treated?

Small bowel cancer treatment is planned specifically for the individual according to the type and stage of the disease. The main goal in treatment is to completely eliminate or control the cancerous tissue.

Surgical intervention and resection

Surgical intervention is the first treatment method frequently preferred in small bowel cancer. Different surgical methods can be applied depending on the size and location of the tumor.

In the resection procedure, surgeons remove the cancerous section and a small portion of the surrounding healthy tissues and reconnect the ends of the intestine. Thus, your digestive system can continue its normal function. If the cancer affects a small section of the small intestine, this method is usually sufficient.

Sometimes it may not be possible to remove all of the cancerous tissue. In this case, surgeons can perform bypass surgery to relieve the obstruction. The bypass procedure allows food to pass by skipping the cancerous area and alleviates your complaints.

For cancers in the duodenum region, the Whipple procedure can be applied. This complex surgical procedure involves the removal of the head of the pancreas, bile ducts, and a portion of the duodenum.

Chemotherapy and HIPEC

Chemotherapy is a treatment method where powerful drugs are used to kill cancer cells. Chemotherapy is recommended if there is a risk of cancer recurrence after surgery or if the cancer has spread to other parts of the body.

HIPEC (Hyperthermic Intraperitoneal Chemotherapy) is a special chemotherapy method applied for intra-abdominal cancers. In this treatment, after tumors are removed with a surgical procedure, chemotherapy drugs heated to 41-43 degrees are given into the abdomen. This fluid is circulated in the abdomen for approximately 60-90 minutes. Heated chemotherapy penetrates cancer cells more effectively and kills small tumor cells that cannot be seen with the naked eye.

Radiotherapy and immunotherapy

Radiotherapy is a treatment method used less frequently in small bowel cancer. It is generally preferred to destroy remaining cancer cells after surgery, reduce pain, or stop bleeding.

Immunotherapy is a treatment approach that helps your immune system fight cancer. Cancer cells sometimes produce special proteins to escape the immune system. Immunotherapy drugs interfere with this process, enabling the immune system to recognize and destroy cancer cells. It can be used in patients deemed suitable according to test results, especially in advanced-stage small bowel cancer.

Multidisciplinary treatment approach

The key to success in small bowel cancer treatment is the multidisciplinary approach where physicians from different areas of expertise come together. A team including a gastroenterologist, surgeon, oncologist, radiologist, and pathologist creates the most appropriate treatment plan for each patient.

Your treatment plan is personalized according to the type and stage of the cancer, the location of the tumor, whether there is intestinal obstruction, and your general health status. While a single treatment is sufficient in some cases, in most cases, the application of different treatment methods together (combined treatment) gives more effective results.

In early stages, a long, disease-free life is possible with surgical intervention. However, even in advanced stages, your life expectancy can be extended and your quality of life can be increased with modern treatment methods.

In summary, Small Bowel Cancer

Although small bowel cancer is rare, knowing its symptoms can save lives. It is extremely important to consult your doctor, especially when you experience unexplained abdominal pain, weight loss, and digestive problems. Remember that early diagnosis greatly increases treatment success.

The diagnostic process can sometimes be long and complex. However, thanks to modern imaging methods and endoscopic procedures, the disease can now be detected more easily. For this reason, you should take your complaints seriously and not neglect the necessary check-ups.

Treatment options include surgery, chemotherapy, radiotherapy, and immunotherapy. Your doctor will determine the most appropriate treatment for you according to the type, location, and stage of the disease. In addition, each patient's treatment is planned specifically for the individual.

Knowing the risk factors and making lifestyle changes are also important. Healthy nutrition, regular exercise, and reducing cigarette-alcohol consumption help protect your bowel health. In addition, if you have a genetic predisposition, it will be beneficial to have regular screenings.

As a result, having knowledge about small bowel cancer and paying attention to the signals your body sends is of vital importance. With early diagnosis and correct treatment, it is possible to get successful results in this disease. If you have concerns about your health, you should consult a specialist without delay.

Frequently Asked Questions

You can find the answers to the questions you are curious about regarding small bowel cancer in this section. We have compiled the most frequently asked questions for a better understanding of the disease.

At what ages is small bowel cancer seen? This type of cancer is generally seen more commonly in people aged 60 and over. However, it can rarely appear at young ages; genetic factors can be effective, especially.

Where does small bowel cancer metastasize? The liver, lungs, and intra-abdominal lymph nodes are the regions where metastasis is most frequently seen.

Does small bowel cancer heal completely? Yes, complete recovery is possible in cases diagnosed at an early stage and treated appropriately. Early diagnosis significantly increases the success rate. Where is small bowel pain felt? Such pains are usually felt around the navel.

Can cancer recur after treatment? Yes, there is a risk of recurrence after treatment. For this reason, regular doctor check-ups are important.

How long does the chemotherapy process last? The chemotherapy process can last from 6 months to several years depending on the condition of the tumor.

What is small bowel cancer, what are its symptoms, how is it diagnosed, and what are the treatment methods? You can get detailed information about small bowel cancer in this article.