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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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This information is about cancer of the small bowel.
The small bowel is part of the digestive system and extends between the stomach and the large bowel (or colon). The small bowel is divided into three main parts: the duodenum, the jejunum and the ileum.
The small bowel folds many times to fit inside your abdomen and is around five metres (16 feet) long. It is responsible for the breakdown of food that allows vitamins, minerals and nutrients to be absorbed into the body.
Diagram showing the position of the small bowel
View a large copy of the diagram showing the position of the small bowel|
Although the small bowel makes up three quarters of the digestive system, cancers in this area are rare. Around 970 people in the UK are diagnosed with small bowel cancer each year.
There are four main types of small bowel cancer, and they are named after the cells where they develop. The types are: adenocarcinoma, sarcoma, carcinoid tumours| and lymphoma|.
These tumours start in the lining of the bowel. They are the most common type of small bowel cancer and usually appear in the duodenum.
These tumours develop in the supportive tissues of the body. Leiomyosarcomas| usually grow in the muscle wall of the small bowel, most commonly in the ileum. Gastrointestinal stromal tumours (GISTs)|, which can develop in any part of the small bowel, are another rare type of sarcoma.
These start from cells that make hormones within the small bowel. These tumours appear most commonly in the ileum and sometimes within the appendix.
These tumours start in the lymph tissue of the small bowel. The lymph tissue is part of the body’s immune system. Usually small bowel lymphomas are non-Hodgkin lymphomas (NHLs)|. They occur most commonly in the jejunum or ileum.
Occasionally a small bowel cancer may be a secondary cancer. This means it has spread from a primary cancer somewhere else in the body.
The information below is mainly about adenocarcinoma of the small bowel. Call us on 0808 808 00 00 for further information about soft tissue sarcomas|, carcinoid tumours and NHL.
The cause of most small bowel cancers is unknown. However, some people with non-cancerous bowel conditions may have a higher risk of developing small bowel cancer. These conditions include Crohn’s disease, coeliac disease and Peutz-Jegher’s syndrome.
People who have had a cancer of the colon or rectum or who have the conditions hereditary non-polyposis colorectal cancer (HNPCC|) or familial adenomatous polyposis (FAP|) also have an increased risk of developing small bowel cancer.
Small bowel cancer, like all cancers, is not infectious and can't be passed on to other people.
The symptoms of small bowel cancer are often vague and difficult to diagnose.
They may include any of the following:
These symptoms may be caused by many things other than small bowel cancer but symptoms that are severe, get worse, or last for a few weeks should always be checked by your doctor.
Occasionally the cancer can cause a blockage (obstruction) in the bowel, which may be complete or partial. The symptoms of this are vomiting|, constipation|, griping pain and a bloated feeling in the abdomen (tummy).
Sometimes a blockage in the small bowel can cause the bowel to tear. This is a serious condition that usually occurs suddenly and needs to be treated with surgery. The symptoms include severe pain, shock (a drop in blood pressure) and abdominal swelling.
Usually you begin by seeing your GP who will examine you and arrange for further tests that may be necessary. Your GP will refer you to a hospital specialist for these tests and for expert advice and treatment.
At the hospital, the doctor will ask you about your general health and any previous medical problems. They will examine you and take blood samples to check for anaemia and that your liver is working properly. You may also have a chest x-ray to check your lungs and heart. You may be asked to take a sample of your stool (bowel movement) to the hospital so that it can be tested for blood.
The following tests are commonly used to diagnose small bowel cancers:
These tests allow the doctor to look inside the duodenum and the upper part of the jejunum, or the lower part of the ileum. The test may be done in the hospital's outpatient department or on a ward.
You will be asked to lie on your side and given a mild sedative to help you relax. The doctor gently passes a thin tube either down your throat and through your stomach (endoscopy) or into your back passage (colonoscopy). There is a light and lens at the end of the tube to help the doctor to see any abnormal areas.
If necessary, a small sample of cells can be taken (called a biopsy) for examination under a microscope by a pathologist.
Unfortunately these tests do not reach some areas of the jejunum or the ileum, so different tests are needed to find tumours in these areas.
This test takes pictures of the whole of the inside of your digestive tract, including all of your small bowel.
You swallow a capsule about the size of a large pill. Inside the capsule is a camera, a battery, a light and a transmitter. The camera takes two pictures a second for eight hours. The pictures are sent to a small recording device attached to a belt you wear round your waist.
You have to follow a special diet the day before and on the day of the test. Your nurse or doctor will give you instructions about this. Otherwise you can carry on with your normal activities while the camera is taking pictures.
About eight hours after swallowing the capsule you return the recording device to the hospital. The pictures from the recorder are loaded onto a computer and will be looked at by your doctor.
The capsule is disposable and is usually passed out naturally in bowel motions. If the capsule is not passed out of your system, you may need to have an operation to remove it.
This is a special x-ray of the small bowel, sometimes called a barium meal or barium follow-through. It is done in the hospital x-ray department. For this test it's important that the bowel is empty so that a clear picture can be seen. Your hospital will give you instructions, but it is likely that on the day before your test you will be asked to take a laxative and drink plenty of fluids to help empty your bowel.
On the day of your barium x-ray, you should have nothing to eat or drink. You will be asked to drink a fluid that contains barium, a substance that shows up white on x-ray. The doctor can watch the passage of the barium through the whole of the small bowel on a screen to look for any abnormalities.
For a couple of days after the test your stools may be white. This is the barium passing out of your body and is nothing to worry about. The barium can also cause constipation so you may need to take a mild laxative for a couple of days.
Sometimes it's difficult to get a clear picture of the small bowel, and biopsies can't always be taken, so diagnosis may be made during an operation.
The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the type and the stage of the cancer helps the doctors to decide on the best treatment.
Cancer can spread in the body, either in the bloodstream or through the lymphatic system|. The lymphatic system is part of the body’s defence against infection and disease. The system is made up of a network of lymph nodes that are linked by fine ducts containing lymph fluid. Your doctors will usually check the lymph nodes close to the small bowel to help find the stage of the cancer.
The cancer is contained within the lining of the small bowel or has spread into the muscle wall, but has not begun to spread to the lymph nodes or other parts of the body.
The cancer has spread through the muscle wall and may affect other nearby structures such as the pancreas.
The cancer has spread to nearby lymph nodes.
The cancer has spread to nearby lymph nodes and also to other parts of the body such as the lungs.
If the cancer comes back after initial treatment, this is known as recurrent cancer.
This will depend upon a number of things, including your age, your general health, the position, size and exact type of cancer, and whether it has spread. The treatments for each type of small bowel cancer may vary.
Before you have any treatment, your doctor will give you full information about what it involves and explain its aims to you. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment.
No medical treatment can be given without your consent.
Treatment can be given for different reasons and the potential benefits will vary for each person. If you have been offered treatment that aims to cure your cancer, deciding whether to have the treatment may not be difficult. However, if a cure is not possible and the treatment is to control the cancer for a period of time, it may be more difficult to decide whether or not to go ahead.
If you feel you can't make a decision about treatment when it is first explained to you, you can always ask for more time to decide.
You are free to choose not to have the treatment and the staff can explain what may happen if you don't have it. You don't have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.
Surgery| is the main treatment for cancer of the small bowel. Surgery may be used to remove the tumour and join the bowel back together. It may also be used if there is a blockage within the bowel.
Often it's possible to remove the whole tumour during an operation but this is not the case for everyone. The position of the tumour within the bowel and how much of the bowel is involved will determine how extensive the surgery is. It may be necessary to remove part of the stomach, colon, the gall bladder or the surrounding lymph nodes during the surgery.
Usually the bowel can be joined together again during surgery (an anastomosis). If for some reason this isn't possible, the end of the bowel will be brought out to the skin of the abdominal wall. This opening is called a stoma and the procedure is known as an ileostomy. A bag is worn over the stoma to collect bowel motions. Usually the ileostomy will be temporary and a further operation to rejoin the bowel can be done a few months later. Very rarely, the ileostomy may be permanent.
If the cancer is large and has caused a blockage in the small bowel it is sometimes possible to bypass the tumour to relieve the symptoms, even if it's not possible to completely remove the tumour.
Your surgeon will explain your operation to you and can answer any questions you may have. Sometimes, however, the surgeon may not know exactly what can be done until during the operation.
After a major operation you may have to stay in an intensive care ward for a couple of days before being moved back to a general ward.
When part of the small bowel has been removed or bypassed, you may need to have a special diet, supplements or medicines. This will depend on the extent of the surgery, and is intended to help with the digestion and absorption of food. Your doctor or nurse will explain this to you.
Our cancer support specialists| can give you further information about having an ileostomy. The stoma care nurse at the hospital will help you look after the stoma for the first few days, and can give you support and information on caring for your stoma when you go home.
Radiotherapy| is the use of high-energy rays to destroy cancer cells while doing as little harm as possible to normal cells.
It is not commonly used in the treatment of small bowel cancers. However, for some people, it may be used following surgery, or in combination with chemotherapy.
Chemotherapy| is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.
Occasionally chemotherapy may be used to treat cancer of the small bowel, in combination with radiotherapy or surgery or on its own. The drugs most commonly used are fluorouracil| (5FU), oxaliplatin| (Eloxatin®) and irinotecan| (Campto®).
Chemotherapy is not always suitable and its effectiveness in treating small bowel cancer is still being researched.
Imatinib| (Glivec®) may be used to treat a GIST in the small bowel. It blocks a chemical that the cancer needs in order to grow.
Other drugs or newer approaches to treating cancer may also be given in certain situations. These may help to control the cancer or any symptoms.
After your treatment has been completed, your doctor will ask you to go back to hospital for regular check-ups and x-rays or scans. These are good opportunities to discuss with your doctor any worries or problems you may have. However, if you notice any new symptoms or are anxious about anything else between appointments, contact your doctor or nurse for advice.
Research into treatments for cancer of the small bowel is ongoing and advances are being made. Cancer doctors use clinical trials| to assess new treatments.
You may be asked to take part in a clinical trial. Your doctor will discuss the treatment with you so that you have a full understanding of the trial and what it means to take part.
Having investigations and treatment for cancer can be a very stressful experience. You may have many emotions| including anxiety, anger and fear. These are all normal reactions and are part of the process many people go through when they are trying to come to terms with their condition.
Many people find it helpful to talk things over with their doctor or nurse, or with one of our cancer support specialists|. Close friends and family members can also offer support.
This section has been compiled using information from a number of reliable sources including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.