Intestinal Cancer

(Adenocarcinoma, Carcinoid, Intestinal Lymphoma, Leiomyosarcoma)

Intestinal cancer usually refers to a malignancy of the small intestine. It is relatively rare in the United States, with only about 3,600 new cases a year. (In contrast, cancer of the colon, or large intestine, is second only to lung cancer in prevalence.) When intestinal cancer does occur, it is often in conjunction with other disorders. For example, persons with inflammatory bowel disease have an increased risk of adenocarcinoma, a cancer in which the malignant cells function like glands and produce hormones, mucus, or other glandular substances.

The risk of intestinal lymphoma, a cancer of the lymph structures, increases with the presence of celiac sprue, a type of malabsorption disorder. In many cases, neither adenocarcinoma nor intestinal lymphoma have any symptoms until they begin to spread. Then, there may be pain, bleeding, and an intestinal obstruction.

A rare type of cancer, leiomyosarcoma, develops in the smooth muscle cells of the intestine, and sometimes produces large tumors that can be felt by pressing on the abdomen.

Still another type of intestinal cancer is a carcinoid tumor, a slow-growing malignancy that secretes a number of hormones and other body chemicals, resulting in a constellation of symptoms known as the carcinoid syndrome. These include diarrhea, cramps, hot flashes, and skin flushing. Some patients may also develop asthma and heart valve disease. These cancers commonly arise in the appendix and often spread to the liver.

Diagnostic Studies and Procedures

X-rays taken after swallowing barium can be helpful as an initial study. However, if intestinal cancer is suspected, the primary diagnostic technique is enteroscopy. In this procedure, a thin, flexible tube with lighting and magnifying devices is inserted through the mouth, esophagus, and stomach, into the small intestine, allowing the doctor to view its inner lining. The enteroscope also has attachments that make it easier to suction off secretions or take tissue samples for biopsy studies.

Imaging studies, such as CT scans, MRI, or ultrasonography, may be called for when a carcinoid tumor is suspected. The blood and urine will also be analyzed for the presence of specific chemicals produced by the tumor.

Medical Treatments

Adenocarcinomas and leiomyosarcomas are removed surgically, often followed by radiation therapy. As intestinal cancers tend to recur, repeated operations may be necessary. Chemotherapy also may be administered if the cancer has spread beyond its original site. With intestinal lymphoma, the tumor is removed and follow-up treatment includes abdominal radiation therapy and chemotherapy.

Carcinoid tumors are also taken out, followed by chemotherapy. If the cancer has spread to the liver, the diseased portion of that organ is also removed, if possible. To treat carcinoid syndrome symptoms, various drugs are prescribed, including cimetidine (Tagamet) or ranitidine (Zantac) for flushing, as well as drugs to control diarrhea.

Alternative Therapies

These should be used only as adjuncts to medical treatments for controlling pain and other symptoms. Hypnotherapy. This technique has proved useful in pain management, particularly for advanced cancer.

Meditation. Meditation can reduce stress, help control pain, and improve the quality of life for cancer patients.

Nutrition Therapy. Normal eating may be difficult following intestinal surgery, especially if a large portion of the small intestine has been removed. A clinical dietitian or nutrition therapist who is trained in working with cancer patients should be consulted.

Visualization. This therapy employs guided imaging techniques to visualize the body's white cells fighting the invading cancer cells. It is taught in many cancer centers as a way to help patients cope with the disease.

Self-Treatment

There are measures you can take to help insure that you maintain good nutrition while undergoing treatment:

• Eat small, frequent meals, timed to coincide with periods free of nausea and vomiting. For example, if you normally feel best in the morning, have your main meal then.
• Emphasize bland, easily digested foods that provide maximum nutrition and calories. Good choices include puddings made with whole milk that is enriched with powdered milk, cream soups, pureed or creamed vegetables, ice cream, and milk shakes.
• Food odors often provoke nausea. Stay out of the kitchen as much as possible, and serve foods either cold or at room temperature.
• If diarrhea is a problem, eat a low-residue diet of BRAT (bananas, rice, applesauce, and toast). Or try an oral nutritional supplement that is formulated not to produce solid wastes.

Other Causes of Intestinal Symptoms

Bleeding, with or without pain, may be due to some other type of cancer, inflammatory bowel disease, or a peptic ulcer. Diarrhea and cramping may also be the result of inflammatory bowel disease, irritable bowel syndrome, or a gastrointestinal infection.