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    SMALL INTESTINAL CANCER
    Read the story of ASCP Patient Champion Daryl and learn about
    the role of laboratory testing in the diagnosis and treatment of small intestinal cancer.

WHAT IS THE SMALL INTESTINE?

The small intestine, which is also called the small bowel, is part of the digestive system. The function of the small intestine is to break down food and nutrients before they are absorbed into the body. The small intestine connects the stomach to the large intestine (colon). The small intestine has three parts: the duodenum, jejunum, and ileum. The duodenum is the part closest to the stomach. The jejunum is the middle section. The ileum is the bottom section that connects to the large intestine (also called the colon).

 

RESOURCES

Educational Materials: Small Intestinal Cancer

 

Parts of the Gastrointestinal Tract

WHAT CANCERS OCCUR IN THE SMALL INTESTINE?

Cancer of the small intestine begins in its lining when malignant cells begin to grow uncontrollably. The specific causes of intestinal cancer are not well understood, however genetic and environmental factors play a role. Small intestinal cancer is a type of gastrointestinal cancer, and it contributes to about 3% of gastrointestinal cancer cases. There are several types of small intestinal cancer. Each type is defined by the type of cells where the cancer begins.

Adenocarcinoma: This type of cancer begins in the glandular epithelial cells that line the small intestine. Adenocarcinomas are the most common type of intestinal cancer and contribute to 1 in 3 intestinal cancer cases. Most malignant growths begin in the part of the small intestine closest to the stomach (duodenum) and block the small intestine. The signs and symptoms of adenocarcinoma include bloating, difficulty swallowing, nausea, and feeling full after eating small amounts of food.

Sarcoma: This type of cancer begins in soft tissues such as muscle or cartilage. The most common type of sarcoma in the small intestine is called a gastrointestinal stromal tumor (GIST). Symptoms for GISTs include stomach pain, weight loss, vomiting blood and difficulty swallowing.

Neuroendocrine Tumors: This type of tumor begins in the neuroendocrine cells which help the body produce hormones. Most neuroendocrine tumors (NETs) start in the ileum and are also referred to as carcinoid tumors. NETs are rare and account for less than 1% of intestinal cancer cases. The signs and symptoms of NETs can include flushing on the face and neck, abdominal pain, rectal bleeding and vomiting.

Lymphoma: This type of cancer begins in lymphocytes (a type of white blood cell) that are present within the small bowel wall. The signs and symptoms include unexplained weight loss, abdominal pain, nausea, vomiting and diarrhea.

The normal small bowel, on the left and right of the slide, has finger-like projections (villi) which are responsible for absorption of nutrients. The tumor (large blue/purple mass) has completely replaced the small bowel lining cells. This appearance could be consistent with a primary or a metastatic tumor. Mass-forming lesions like tumors in the small bowel can lead to intussusception (a process where the intestine folds in on itself) which can be painful and a presenting sign of masses.

STAGES OF INTESTINAL CANCER

The stages of intestinal cancer indicate where the cancer has spread throughout the body and the severity of the cancer. At certain stages, the cancer is only in specific parts of the small intestine.

STAGE 0: The cancer is only in the most inner part (epithelium) of the lining of the small intestine.

STAGE I: The cancer has spread to one of the following:

  • The submucosa (just below the epthelium)
  • The layer of muscle in the mucosa
  • The muscularis propia (the larger, outer layer of muscle)

STAGE II: The cancer has grown through the muscularis propia and into the serosa or subserosa, which is the outermost layer of the small intestine. The cancer has not spread to lymph nodes.

STAGE III: The cancer has grown through the muscularis propia and into the serosa or subserosa, which is the outermost layer of the small intestine. The cancer has not spread to lymph nodes.

STAGE IV: The cancer has spread to other parts of the body such as the liver and the lungs.

LAB TESTS RELATED TO SMALL INTESTINAL CANCER

*Please note that reference ranges are set by individual laboratories for their specific populations and might differ slightly.

Biopsy: This test involves the removal of tissue for analysis in the laboratory. For small intestinal cancer, a biopsy can be done during an endoscopy. Biopsy forceps can be used through the endoscope tube to take small samples of the tumor to be tested. If the tumor cannot be reached with an endoscope, a sample is obtained during surgery.

Carcinoembryonic Antigen (CEA): This test measures the level of the protein and tumor marker, CEA in the blood. High levels of CEA in the blood in adults can be an indication of cancer. The typical reference range* is between 0 to 2.5 ng/mL.

Complete Blood Count (CBC): This test determines your overall health status by looking at your overall blood count levels, including your red and white blood cell count, your platelets, and lymphocytes. This test is important because it can indicate if you are having a condition or disease, such as an infection, anemia, inflammation, or cancer. Specifically, a decreased hemoglobin or hematocrit with no known cause can possibly indicate blood loss, which can occur from a bleeding tumor of the small intestine.

 

Questions To Ask Your Doctor

  • What type of small intestinal cancer do I have?
  • How does the type affect my treatment options?
  • What are my treatment options?
  • Why do you recommend this particular treatment option?
  • What are the follow-up tests and what are we looking for?
  • Are there any additional tests that would help better understand my disease prognosis?
  • What screening tests do you recommend?
  • Should I make any dietary or lifestyle changes?

DARYL’S STORY

In 2021, Daryl went to his doctor to get a colonoscopy. He was not having any unusual symptoms, just occasional fatigue and constipation, but his family has a history of cancer, so he asked his doctor to perform a more in-depth exam. During the procedure, the doctor found an unusual mass in Daryl’s terminal ileum —the last segment of the small intestine before it turns into the colon. She performed a biopsy on the mass and sent it to the lab. When the results came back, she told him that the mass they had found was grade 2 bowel neuroendocrine tumor. Daryl had gastrointestinal cancer.

Daryl and his family were very familiar with cancer and the pain it can cause; Daryl’s father passed away in his early sixties from a rare stomach cancer. “I’ve struggled sharing the exact diagnosis with some of my family,” he said, “because on the surface it appears worse than what I believe at this time.”

The type of tumor Daryl had, a carcinoid tumor, is usually slow growing and often do not show signs or symptoms until very late into the progression of the disease. However, they can be caught by routine screenings. “My care team told me that I am lucky due to the early diagnosis, early treatment, the fact the cancer is nonaggressive,” said Daryll, “It is to my benefit that I had annual scans and colonoscopies.”

Three days after his diagnosis, Daryl married his wife, Dana. Once they returned from their honeymoon, Daryl went into surgery to have the tumor removed. In addition to the diseased part of his small intestine, doctors also removed lymph nodes, his appendix and some of his colon. These tissues were all tested by the clinical laboratory team.

The surgery was successful, and Daryl now has no evidence of cancer in his body. To confirm his treatment remains effective, he gets regular colonoscopies and laboratory tests to make sure there is no reoccurrence of the cancer.

He is deeply grateful for the work of lab professionals and pathologists; “They are highly specialized in their diagnostic work. Medical doctors can’t report findings until all testing is completed. It is the collaboration of all of the professionals with various disciplines that create the successful environment for successful treatment.”

daryls-story

“The phone rang three days before our wedding, and the doctor was on the line. She said my lab results were back, and the growth was cancer.”

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