Is Intestinal Adenocarcinoma an Aggressive Cancer?

Compared with some fast-moving cancers with few effective treatments (like pancreatic cancer) intestinal adenocarcinoma is less aggressive. Finding a tumor early means you have an 85% chance of surviving the next five years. Even if the cancer has spread to distant organs, you still have a more than 40% chance of surviving five years after diagnosis.

Adenocarcinoma is a rare type of cancer that occurs when gland cells that line the inside of the small intestine grow out of control.

Adenocarcinomas account for about one-third of all small intestinal cancers. 

What Are Symptoms of Intestinal Adenocarcinoma?

Common symptoms of small intestinal adenocarcinoma include: 

• Abdominal pain
  • Often cramping
  • May not be constant
  • May be severe if the intestinal wall becomes perforated (rare)
• Nausea 
• Vomiting
• Weight loss without trying
• Weakness 
• Tiredness/fatigue
• Dark-colored stools (from bleeding into the intestine)
  • May be black and tarry
  • Can lead to lightheadedness/fainting
• Low red blood cell counts (anemia)
• Yellowing of skin and eyes (jaundice)

The cause of small intestinal adenocarcinoma is unknown. 

Risk factors for developing small intestinal adenocarcinoma include: 

• Gender: occurs slightly more often in men than in women
• Age: occurs more often in older people, and most often found in people in their 60s and 70s
• Race/ethnicity: in the U.S., African Americans are affected more often than people of other races/ethnicities
• Smoking 
• Alcohol use
• Diet
  • Diets high in red meat and salted or smoked foods may increase the risk 
• Celiac disease
• Colon cancer
• Crohn's disease
• Inherited syndromes
  • Familial adenomatous polyposis (FAP)
  • Lynch syndrome (hereditary nonpolyposis colorectal cancer, or HNPCC)
  • Peutz-Jeghers syndrome (PJS)
  • MUTYH-associated polyposis
  • Cystic fibrosis (CF)

Small intestinal adenocarcinomas are diagnosed with a physical examination, patient history, and tests such as: 

• Blood tests
  • Complete blood count (CBC)
  • Blood chemistry tests
• Imaging tests
  • Barium X-ray tests
    • Upper GI series
    • Enteroclysis
    • Barium enema (lower GI series)
  • Computed tomography (CT) scan
    • CT enteroclysis
    • CT-guided needle biopsy
  • Magnetic resonance imaging (MRI)
    • MR enteroclysis
  • Endoscopy
    • Upper endoscopy (also called esophagogastroduodenoscopy or EGD) 
    • Capsule endoscopy
    • Double-balloon enteroscopy (endoscopy)
• Biopsy

Small intestinal adenocarcinoma is treated with one or more of the following: 

• Surgery 
  • The main treatment for adenocarcinoma
  • Segmental resection
    • Removes (resects) the part of the intestine with the tumor, along with some normal tissue on either side of the tumor, and the cut ends of intestine are reattached.
    • Some nearby tissue containing lymph nodes is also removed
  • Pancreaticoduodenectomy (Whipple procedure)
    • Removes the duodenum, part of the pancreas, part of the stomach, and nearby lymph nodes
    • The gallbladder and part of the common bile duct are also removed, and the remaining bile duct is attached to the small intestine so bile from the liver can enter the small intestine
  • Palliative surgery
    • Performed when the cancer cannot be completely removed because it has spread (metastasized) 
    • Can be used to help prevent or relieve some symptoms from the cancer
    • Bypass surgery may be used prevent or relieve a blockage
    • Stent or tube placement may be used to help keep the intestine open and allow digested food to pass
• Chemotherapy, alone or in combination
  • Capecitabine
  • 5-fluorouracil (5-FU)
  • Oxaliplatin
  • Irinotecan
• Radiation therapy 
  • External-beam radiation therapy 
  • May be used for those whose cancer cannot be removed completely with surgery and that causes problems such as pain or bleeding into the intestines
  • May also be used after surgery to try to kill any remaining cancer cells (adjuvant therapy)

Life expectancy for small intestinal adenocarcinoma is often expressed in 5-year survival rates, that is, how many people will be alive 5 years after diagnosis. 

Small intestinal adenocarcinoma 5-year survival rates:

• Localized (no sign the cancer has spread outside the small intestine): 85%
• Regional (cancer has spread outside the small intestine to nearby structures or lymph nodes): 76%
• Distant (cancer has spread to distant parts of the body, such as the liver or peritoneum, the inner lining of the abdomen): 42%