Small intestine carcinoma metastatic

What is small intestine carcinoma metastatic

Small intestine carcinoma metastatic refers to cancer that started in the small intestine and has spread to other parts of the body. The small intestine is a long tube that connects the stomach to the large intestine, and it includes three sections: the duodenum (near the stomach), jejunum (middle section), and ileum (longest section)1.

When cancer cells break away from the original tumor in the small intestine, they can travel through the lymph nodes or bloodstream to other organs, where they form new tumors. This process is called metastasis1. Common places where small intestine cancer spreads include the liver, lungs, and bones2.

Adenocarcinoma is the most common type of small intestine cancer. It starts in the glandular cells that line the inside of the small intestine. About one-third of small intestine cancer cases are adenocarcinomas, and most occur in the part of the small intestine near the stomach. These tumors may grow and block the intestine13.

Small intestine cancer is very rare, making up only 3% of gastrointestinal cancers in the United States1. However, rates of new small intestine cancer cases have been rising by an average of 2.3% each year over the last 10 years4.

Signs and symptoms

The symptoms of metastatic small intestine carcinoma can vary depending on where the cancer has spread and how advanced it is. Sometimes, tumors do not cause symptoms early on and may only be discovered during imaging procedures for unrelated issues1.

Common symptoms include abdominal pain or cramps, often in the middle of the abdomen. Many people experience unexplained weight loss without trying to lose weight35. Nausea, vomiting, and diarrhea may occur as the tumor interferes with normal digestion1.

A lump may be felt in the abdomen as the tumor grows. Blood in the stool is another warning sign - the stool may appear red or black in the toilet53. Some people develop anemia, a condition where the body doesn't have enough healthy red blood cells, which can cause weakness and tiredness1.

Jaundice, which causes yellowing of the skin and the whites of the eyes, may develop if the cancer spreads to the liver or blocks bile ducts15. More advanced cancers can cause serious complications such as perforation (a hole in the intestine), small bowel obstruction (blockage), or obstructive jaundice6.

How it is diagnosed

Diagnosing metastatic small intestine carcinoma requires multiple procedures and tests. The process usually involves looking at the small intestine and the areas around it to determine how far the cancer has spread1.

Healthcare providers begin with a physical exam and health history. They check for general signs of health and look for any lumps or anything else that seems unusual77.

Imaging tests create pictures of the small intestine and surrounding areas. CT scans (computed tomography) and MRI scans (magnetic resonance imaging) are the main imaging tests used to detect small intestine cancer and assess how far it has spread2. A PET scan (positron emission tomography) may also be helpful to decide if surgery is an option for cancer that has spread outside the small intestine2.

A biopsy is a procedure to remove a sample of tissue for testing in a laboratory. For small intestine cancer, the tissue sample is often collected during a colonoscopy or other endoscopic procedure. Sometimes surgery is needed to obtain the tissue sample2. In the lab, tests show whether the cells are cancerous and what type of cancer it is.

Additional tests on the cancer cells can reveal gene changes that affect how the cancer grows and responds to treatment. This information helps doctors understand the outlook and create a treatment plan2.

Blood tests may include measuring carcinoembryonic antigen (CEA), a protein made by some cancer cells. High levels can indicate the presence or progression of cancer, especially in advanced cases8.

Understanding spread of cancer

When doctors describe the stage of small intestine cancer, they may use the words local, regional, or distant. Local means the cancer is only in the small intestine and has not spread to other parts of the body. Regional means the cancer has spread to areas close to or around the small intestine. Distant means the cancer has spread to a part of the body farther from the small intestine2.

Stage 4 small intestine cancer means the cancer has spread to other parts of the body, such as to the liver, lungs, or bones. This is also called metastatic small intestine cancer2. At this stage, the cancer has traveled beyond the original site and formed new tumors in distant organs.

The process used to find out if cancer cells have spread within and around the small intestine is called staging. Staging is important because it helps the healthcare team plan treatment33.

Metastatic small intestine adenocarcinoma often comes back after treatment, which is called recurrent cancer. If it comes back in the same place where it first started, it's called local recurrence. If it comes back in tissues or lymph nodes close to where it first started, it's called regional recurrence. It can also return in another part of the body, which is called distant metastasis or distant recurrence9.

Treatment approaches

Treatment for metastatic small intestine carcinoma depends on several factors including the location of the cancer, where it has spread, your overall health, and your preferences. When the cancer cannot be completely removed by surgery, it is called unresectable10.

Chemotherapy is the primary treatment for metastatic small intestine adenocarcinoma. Chemotherapy uses anticancer drugs to destroy cancer cells109. Because this type of cancer is rare, there is no standard chemotherapy regimen. Common chemotherapy drugs and combinations include FOLFOX (leucovorin, 5-fluorouracil, and oxaliplatin), CAPOX (capecitabine and oxaliplatin), 5-FU or capecitabine alone, and FOLFIRI (leucovorin, 5-FU, and irinotecan)9.

Targeted therapy uses drugs to target specific molecules on cancer cells or inside them to stop the growth and spread of cancer. For metastatic small intestine adenocarcinoma with an NTRK gene fusion (a specific genetic change), drugs like larotrectinib or entrectinib may be used9.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. These drugs may be offered for recurrent or metastatic small intestine adenocarcinoma if the tumor has certain genetic changes defined as high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR). These treatments will only be tried if the cancer has spread and doesn't respond to other treatments9.

Surgery may still play a role even when cancer has spread. In certain cases, if cancer has spread to just one other body part and the surgeon can completely remove this along with the cancer in the small intestine, it may help control the disease210.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It may be used to shrink tumors before surgery or to help control symptoms510.

Outlook and prognosis

The outlook for metastatic small intestine carcinoma depends on numerous factors, including the cancer type, its stage, where the tumor started in the small intestine, and how well the cancer responds to treatment1.

As with other gastrointestinal cancers, cure relates to the ability to completely remove the cancer through surgery. When cancer has spread to distant organs, complete removal is often not possible11. However, treatment can keep the cancer under control, relieve symptoms, and give patients a good quality of life2.

In a few people with metastatic small intestine cancer, treatment can control the cancer for a long time. For a small number of these people, a cure might be possible. This is usually only possible if the cancer has spread to just one other body part and the surgeon can completely remove it along with the cancer in the bowel2.

Treatment for metastatic cancer is usually considered palliative, meaning it focuses on controlling symptoms and maintaining quality of life rather than curing the disease912.

Supportive care and coping

Supportive care helps people meet the physical, practical, emotional, and spiritual challenges of cancer. It is an important part of cancer care and focuses on improving quality of life12.

Finding out that cancer cannot be cured is distressing and can be a shock. It's common to feel uncertain and anxious, and normal to not be able to think about anything else. Many people find that knowing more about their situation can make it easier to cope12.

If a large part of the small intestine is removed during treatment, some people develop short bowel syndrome. This happens when there isn't enough intestinal tissue left to properly absorb nutrients and water from food. Symptoms include diarrhea, cramping, bloating, changes to stool appearance, heartburn, weakness, and fatigue. Treatment may include vitamin and mineral supplements, a high-calorie diet, eating small meals often, oral rehydration solutions, tube feeding, or parenteral nutrition (liquid nutrients delivered through a vein)12.

Fear that cancer will come back after treatment is normal and common. Many people with small intestine adenocarcinoma are diagnosed when the cancer is very advanced, which can be particularly difficult to understand and accept12.

Talking about advanced cancer with friends and relatives can help increase trust and support. Sharing can make it easier to plan ahead. However, some families may not want to discuss it because they worry about the emotions involved. You can help by letting them know you would like to discuss what's happening and how you feel12.

Counseling might help you find ways of coping with your feelings and emotions. Community cancer nurses or symptom control nurses can help support you at home12.