Small Intestine Cancer

Small bowel cancers are considered extremely rare in India and no detailed information is available spectrum and outcomes. Small intestine cancers include adenocarcinoma, lymphoma, neuroendocrine tumors (NET), gastrointestinal stromal tumors (GIST) and sarcoma. Our team has published one of the most comprehensive study on current oncological standards for surgery for small bowel cancers in India 

The most common symptom of small intestinal tumors is weight loss. When the tumor becomes advanced symptoms due to luminal obstruction – colicky abdominal pain and vomiting are common. Tumors such as GISTs may present with black tarry stools or melena due to GI tract bleeding.

Diagnosis of small bowel tumors is often made at abdominal CT scan performed during investigations for non specific abdominal symptoms (vide supra). Enteroscopy (capsule / double balloon) may then be performed for more detailed assessment. The latter has advantage that biopsy can also be taken during the procedure.

Surgery with radical resection of the affected segment (i.e. surgical removal of the diseased segment and its mesentery with draining lymph nodes) is the only treatment consistent with long term survival. The extent of surgery would depend on the location of the tumor – adenocarcinoma of second part of duodenum requires Whipple’s procedure while tumors situated distally towards the cecum (initial part of large intestine) may require right hemicolectomy.

In patients who present with advanced tumors where curative surgery is not feasible a ‘bypass’ operation may be performed. 

In one study from the US, the 5 year overall survival for adenocarcinoma was reported to be 34.9%. This study further reported that only surgery improved survival and addition of chemotherapy after surgery (adjuvant chemotherapy) did not confer survival advantage when compared to surgery alone. (Diseases of Colon and Rectum 2016). However, recent NCCN guidelines 20202 recommend adjuvant chemotherapy for stage III (lymph node positive tumor) small intestine adenocarcinoma.