Small Intestine Cancer (Lymphoma of the Small Intestine)

What is Small Intestine Cancer?

Lymphomas of the small bowel may be primary (i.e. arising from the small bowel lymph tissue) or secondary to a systemic lymphoma. The small bowel is composed of the duodenum, jejenum, and ileum. It is the part of the Gastro-Intestinal tract extending from the pyloric sphincter of the stomach to the ileo-caecal valve separating the ileum from the colon (large bowel).

The small bowel is important for the breakdown and absorption of nutrients from digested food. Food that is partly digested by the acids in the stomach continues to be broken down by enzymes from the pancreas - which drain into the duedenum at the ampulla of vater. Bile salts from the liver and gallbladder also drain into the duedenum at the ampulla of vater. After further digestion, food constituents such as proteins, fats, and carbohydrates are broken down to small building blocks and absorbed into the enteric circulation.

Statistics on Small Intestine Cancer?

Primary lymphomas of the small intestine are rare - comprising 1-3% of gastro-intestinal malignancies, however, they are the second most common small bowel tumour after adenocarcinomas.

Risk Factors for Small Intestine Cancer

Predisposing factors may include:

Crohn's disease.

Coeliac disease.

Immunosuppressive diseases - e.g. AIDS.

Progression of Small Intestine Cancer

The boewl cancer may grow locally into the lumen of the bowel causing obstruction, or sometimes causing perforation. Sometimes the bowel cancer spread along the mucosal surface to involve a wide area - causing malabsorption. Lymph node spread to mesenteric nodes, and subsequently other lymph node groups and systemic spread may occur similar to other lymphomas.

How is Small Intestine Cancer Diagnosed?

FBC - may reveal anaemia (low Hb) due to chronic blood loss with iron deficiency.An abdominal x-ray may reveal signs of small bowel obstruction.

Prognosis of Small Intestine Cancer

Bowel cancer prognosis depends on the stage at which the disease is diagnosed and treated. With tumours treated adequately with a curative intent the 5 year survival is as much as 80%. Even with more advanced disease there may be favourable prognosis if the tumour responds to chemotherapy.

How is Small Intestine Cancer Treated?

Adequate management depends on accurate diagnosis and staging.

Surgical management involves resection of the involved bowel segment with draining mesenteric lymph nodes. Even with advanced disease this may be beneficial to avoid complications of bleeding and perforation. Tissue is obtained at the same time for accurate histological diagnosis if not already obtained. A liver biopsy and sampling of distant nodes may also be performed.

Chemotherapy regimes are usually used after surgery to reduce chances of systemic spread. Adriamycin is usually included in the regime.