Small Intestine

What is the ? The is slightly longer than the The small intestine, also called the small . Vitamin B12 and bile salts are bowel, is part of the body’s gastrointestinal absorbed at the end of the ileum. Water and tract (GI) or digestive system. Its jobs are to: lipids (fats) are absorbed throughout the • Break down food. small intestine. The appendix is found near • Absorb the nutrients in food. the section where the ileum meets the large • Move the extra waste to the large intestine. intestine or colon to pass out of the body by the rectum. What is small intestinal cancer? There are 5 main types: 1. tumors 2. Gastrointestinal stromal tumors (GIST) 3. Sarcomas 4. 5.

Cancers of the small intestine are rare. The first four make up 60-70% of all of the small intestine.

What are the risk factors? • A high-fat diet • Crohn’s disease The small intestine is about 22 feet long. It • Celiac disease folds and loops around many times so that it • Smoking can fit in the belly. • Alcohol use

The small intestine has 3 parts: You are also at increased risk if you have: • Duodendum • Familial adenomatous polyposis • Jejunum (FAP) • Ileum • Hereditary nonpolyposis (HNPCC/Lynch Syndrome) The duodendum is the first and shortest • Peutz-Jeghers syndrome (PJS) section of the small intestine. It is about 8 • MUTYH-associated polyposis inches long. The stomach passes food into • Cystic fibrosis the duodenum. The pancreatic and bile ducts attach to the duodenum. They release enzymes to break down nutrients so they can be absorbed.

Most nutrients in food are absorbed into the bloodstream in the jejunum. What are the symptoms? • Biopsy checks tissue under a The early symptoms of a small bowel tumor microscope to learn if it is cancer can be hard to notice. Symptoms include: and where it came from. Biopsies • Pain in the mid-abdomen (belly) that may be done during surgery, during may get worse with eating an upper endoscopy or colonoscopy. • Weight loss We can also do biopsies through the • Nausea wall of the abdomen using a CT scan • Bloating or ultrasound. • A lump in the abdomen • Blood in the stool/black stools These tests will also help us figure out the • Feeling tired due to anemia stage, or extent of the cancer which will help us make a treatment plan. As the tumor grows it may cause a blockage of the small bowel. This could cause severe To stage your cancer, a doctor looks at pain, nausea and vomiting. tissue under the microscope to learn: • The extent of the tumor How is it diagnosed? • Whether the tumor has metastasized • History and physical exam will (spread) to nearby lymph nodes review your symptoms, health habits, • Whether the tumor has spread to past illnesses and treatments. distant organs • Blood tests check the white blood cells, platelets, and hemoglobin and Stage I hematocrit. Blood tests also help us The cancer has grown through the first few look for signs that the cancer is layers of the small intestine wall. It has not hurting other organs. spread to the lymph nodes. • Barium swallow test x-rays the upper GI tract after you swallow Stage II barium (contrast liquid). There are 2 parts of stage II: • • Endoscopy looks at the upper GI Stage IIA tract through a long, lighted tube The cancer has grown through most while you are sedated. The doctor of the layers of the intestine. It has may take pictures and biopsies. not spread to the lymph nodes. • • CT scan is series of pictures of the Stage IIB inside of the body taken after oral or The cancer has grown through the IV contrast. small intestine wall or into nearby tissues or organs. It has not spread to • MRI uses a magnet, radio waves and a computer to take pictures of the nearby lymph nodes or distant inside of the body. organs.

• Colonoscopy may help find tumors Stage III in the lower part of the small There are three parts of stage III: intestine. • Stage IIIA • Laparoscopy is a surgery done with The cancer has grown through the a scope that lets the surgeon check first few layers of the small intestine the belly for signs of cancer. wall and has spread to 1-3 close lymph nodes. • Stage IIIB Radiation therapy is a treatment that uses The cancer has grown through most high energy x-rays or other types of of the layers of the small intestine radiation to kill cancer cells, or slow their and has spread to 1-3 lymph nodes. growth. It treats a very specific area. This is Or, it has grown through the intestine called regional treatment. Chemotherapy wall, spread to other parts of the (chemo) and radiation are sometimes both small intestine, and spread to 1-3 used. This makes the radiation work better. lymph nodes. • Stage IIIC Chemo uses drugs to kill cancer cells or to The cancer has grown through at stop them from growing. When chemo is least one layer of the intestine wall, given through an IV or taken in pill form it may have spread to other parts of the enters the blood stream and can reach cancer intestine, and has spread to more cells throughout the body. This is called than 4 lymph nodes. systemic treatment.

Stage IV Clinical Trials The cancer has spread to other organs such You may have the chance to take part in a as the liver, lungs, (the lining of clinical trial. Clinical trials are controlled the abdomen), or ovaries. research studies done to find out if new cancer treatments work and are safe, or are What is the prognosis? better than the standard treatments. The prognosis (chance of recovery) depends upon many factors: Follow-Up Tests • The type of tumor During your treatments you will need blood • The size of the tumor and how deep tests and scans to see how well the treatment it has grown into the lining of the is working. These tests help make choices to small intestine keep going, stop, or change treatments. This • If it all the tumor can be removed is called restaging. • If it has spread to other parts of the body Blood tests and scans will be done from time to time after you have finished your • If it is a new diagnosis treatments. They can show if your cancer

has come back. How is it treated? Surgery is the most common treatment. A surgeon may take out part or all of an organ that has cancer. Lymph nodes in the area are taken out and checked to see if the cancer has spread. Sometimes the tumor cannot be taken out, but you may still need surgery to treat a blockage.

Your health care team may have given you this information as part of your care. If so, please use it and call if you have any questions. If this information was not given to you as part of your care, please check with your doctor. This is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person’s health needs are different, you should talk with your doctor or others on your health care team when using this information. If you have an emergency, please call 911. Copyright © 10/2019 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7473