Specialist’s Corner
Dr Deepak K Agarwal
The writer is senior consultant gastroenterologist, hepatologist & endoscopist and is running a successful medical Centre in Lucknow
Small bowel cancer is an uncommon type of cancer that occurs in the small intestine. Your small intestine, which is also called the small bowel, is a long tube that carries digested food between your stomach and your large intestine, also called colon. The small intestine is responsible for digesting and absorbing nutrients from the foods you eat. It produces hormones that help with digestion. The small intestine also plays a role in your body's germ-fighting immune system, as it contains cells that fight bacteria and viruses that enter your body through your mouth.
In general, small bowel cancer begins when healthy cells in the small bowel develop changes (mutations) in their DNA. A cell's DNA contains a set of instructions that tell a cell what to do. Healthy cells grow and divide in an orderly way to keep your body functioning normally. But when a cell's DNA is damaged and becomes cancerous, cells continue to divide — even when new cells aren't needed. As these cells accumulate, they form a tumor. With time, the cancer cells can grow to invade and destroy normal tissue nearby. And cancerous cells can spread to other parts of the body.
Doctors aren’t really sure why people develop it. But they do know that several things can increase your chances of getting the disease: How old you are- average age at diagnosis is 60; your sex -slightly higher risk in men; genetics- some disorders you’re born with raise the odds; smoking and alcohol use; high-fat diet; living or working near large quantities of some chemicals, like phenoxyacetic acid. Factors that may increase the risk of small bowel cancer include gene mutations passed through families. Some gene mutations that are inherited from your parents can increase your risk of small bowel cancer and other cancers. Other diseases and conditions that affect the intestines may increase the risk of small bowel cancer, including Crohn's disease, inflammatory bowel disease and celiac disease. If your body's germ-fighting immune system is weakened, you may have an increased risk of small bowel cancer. Examples include people with HIV infection and those who take anti-rejection medicine after an organ transplant. Small bowel cancer can cause complications, including an increased risk of other cancers. People who have small bowel cancer run a higher risk of having other types of cancers, including those that affect the colon, rectum, ovaries and the lining of the uterus. Advanced small bowel cancer can spread to other parts of the body, most often the liver.
There are five types of small intestine cancer
Adenocarcinomas: These make up an estimated 30% to 40% of cases. An adenocarcinoma starts in the lining of the small intestine. At first, it may look like a small, noncancerous growth called a polyp, but over time it can turn into cancer.
Sarcoma: Cancerous cells develop in the soft tissue of the small intestine.
Carcinoid tumors: These slow-growing cancers often take root in the lower section of the small intestine. They might also affect your appendix or rectum. These tumors give off large amounts of certain body chemicals, like serotonin.
Gastrointestinal stromal tumors: This is a rare form of small intestine cancer. More than half of them start in the stomach. Not all GISTs are cancerous.
Intestinal lymphomas: A lymphoma is a cancer that starts in the lymph nodes. People who develop them often have a type of immunodeficiency disorder. That means your body’s natural defense system is weakened and may not fight infection and disease the way it should.
To detect the disease, the doctors will do a thorough medical exam. They’ll ask about a patient’s medical history and any problems he may be having. They are likely order imaging tests. These create pictures of your small bowel so they can see if there’s cancer and whether it has spread. Tests might include X-rays, a CT scan, or MRI. They might also order an endoscopy. That is a procedure where your doctor looks at the inside of your esophagus, stomach, and first part of your small intestine. To do this, they’ll use an endoscope, which is a thin, tubelike instrument that has a light and camera at the end of it. You’ll be given medication to sedate you for the procedure. Other tests your doctor might order include the following: Blood chemistry tests. These measure the amount of certain substances your body is making.; liver function tests. Your doctor checks your blood to measure substances released by your liver and in what quantity; Fecal occult blood test. This detects blood in your stool; Lymph node biopsy. Your doctor removes a piece of your lymph node to check for cancer cells; Laparotomy. This is major surgery. A doctor cuts into the wall of your abdomen to look for signs of disease.
See your doctor if you notice any of the following signs, which could be caused by small intestine cancer or something else: Pain or cramps in the middle of your stomach; losing weight for no known reason; a lump in your abdomen or blood in your stool. The treatment your doctor recommends will depend on a number of things, like what type of cancer it is and whether it has spread. Surgery is the most common treatment. Your surgeon may remove the part of the small intestine that contains cancer. Or they may do bypass surgery so that food can go around a tumor that can’t be removed. Even if your doctor takes out all of the cancer during surgery, they may still suggest radiation therapy. This uses high-energy X-rays to kill cancer cells. They might also offer chemotherapy. These are drugs you take by mouth or through an IV tube. They, too, kill cancer cells or stop them from growing. A number of new therapies are being tested, as well.
It is not clear what may help to reduce the risk of small bowel cancer, since it is very uncommon. If you're interested in reducing your risk of cancer in general, it may help to: Eat a variety of fruits, vegetables and whole grains. Fruits, vegetables and whole grains contain vitamins, minerals, fiber and antioxidants, which may help reduce your risk of cancer and other diseases. Choose a variety of fruits and vegetables so that you get an array of vitamins and nutrients; drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount of alcohol you drink to no more than one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger; Stop smoking. Talk to your doctor about ways to quit that may work for you; exercise most days of the week. Try to get at least 30 minutes of exercise on most days. If you've been inactive, start slowly and build up gradually to 30 minutes. Also, talk to your doctor before starting any exercise programme; maintain a healthy weight. If you are at a healthy weight, work to maintain your weight by combining a healthy diet with daily exercise. If you need to lose weight, ask your doctor about healthy ways to achieve your goal. Aim to lose weight slowly by increasing the amount of exercise you get and reducing the number of calories you eat.
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