3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, Singapore 228510

Small Bowel Tumours

Small Bowel Tumours

What is a small bowel tumour?

A small bowel tumour refers to an abnormal growth of tissue within the small intestine, which is a critical part of the digestive system — responsible for absorbing nutrients and aiding in digestion. These tumours can be benign (non-cancerous) or malignant (cancerous). Their occurrence is relatively rare compared to other gastrointestinal cancers, which makes their diagnosis and treatment quite challenging.

The small bowel, also called the small intestine, consists of three parts: the duodenum, jejunum, and ileum. Tumours can develop in any of these regions, potentially leading to varied symptoms and complications depending on their size, type, and location. Small bowel tumours account for less than 5% of all gastrointestinal tumours but are clinically significant due to the risk of delayed diagnosis.

Common types of small bowel tumours include:

  • Adenocarcinomas — typically arise in the duodenum and are associated with long-standing inflammatory conditions such as Crohn’s disease or celiac disease.
  • Carcinoid tumours — slow-growing tumours that often originate in the ileum and can release hormones, causing systemic symptoms like flushing and diarrhoea.
  • Gastrointestinal Stromal Tumours (GISTs) — rare tumours that develop from the interstitial cells of Cajal, which are part of the intestinal wall.
  • Lymphomas — malignant tumours of the lymphatic system that can affect the small intestine, often in patients with weakened immune systems.
  • Benign tumours — these include lipomas, leiomyomas, and polyps that rarely cause symptoms unless they grow large enough to obstruct the intestine.
The small bowel (small intestine) includes the duodenum, jejunum, and ileum, essential for digestion and nutrient absorption. The length of the small bowel ranges from 4 to 6 metres.

What causes a small bowel tumour?

The development of a small bowel tumour begins at the cellular level, often due to disruptions in the normal processes of cell growth and repair within the small intestine. The cells lining the small intestine undergo constant renewal, and when genetic mutations occur in the DNA of these cells, they can disrupt the mechanisms controlling cell division and apoptosis (programmed cell death). This disruption can lead to uncontrolled cell growth, forming a mass or tumour.

In some cases, these mutations affect proto-oncogenes, which regulate normal cell growth, converting them into oncogenes that drive cancerous growth. Similarly, mutations in tumour suppressor genes, which normally prevent abnormal cell proliferation, can result in the loss of this regulatory function, further contributing to tumour formation.

The unique microenvironment of the small bowel, with its high turnover rate of epithelial cells and exposure to digestive enzymes and bile, may also influence tumourigenesis. While the underlying mechanisms are complex and vary depending on the tumour type, they involve a combination of genetic changes and cellular dysregulation that promote tumour growth.

What are the symptoms of a small bowel tumour?

Small bowel tumours often present with non-specific symptoms that can vary depending on the size, type, and location of the tumour. Many symptoms overlap with other gastrointestinal conditions, which can make early diagnosis challenging. Common symptoms include:
  • Abdominal pain or cramping — often intermittent and may worsen over time.
  • Unexplained weight loss — occurs due to impaired digestion or absorption of nutrients.
  • Nausea and vomiting — particularly in cases of obstruction caused by the tumour.
  • Changes in bowel habits — including diarrhoea, constipation, or a combination of both.
  • Gastrointestinal bleeding — manifesting as blood in stools or black, tarry stools.
  • Fatigue and weakness — often due to anaemia resulting from chronic blood loss.
  • Bloating and fullness — a feeling of fullness even after eating small amounts.
  • Jaundice — if the tumour obstructs bile flow, particularly in the duodenum.

These symptoms warrant medical attention, as they may indicate the presence of a tumour or other gastrointestinal disorders requiring further investigation.

Small bowel tumours may cause severe abdominal pain due to obstruction or pressure on surrounding tissues.

Who is at risk of small bowel tumour in Singapore?

Certain individuals are more likely to develop small bowel tumours due to a combination of genetic, environmental, and medical factors. In Singapore, specific risk factors include:

  • Age — the likelihood increases in individuals aged 60 and above.
  • Family history of cancer — especially gastrointestinal cancers or hereditary syndromes like Lynch syndrome and familial adenomatous polyposis (FAP).
  • Chronic inflammatory conditions — diseases like Crohn’s disease or celiac disease that affect the small intestine.
  • Dietary habits — high-fat, low-fiber diets may play a role in tumour development. This is not very  definitive based on current evidence
  • Smoking and alcohol consumption — linked to higher risks of gastrointestinal cancers.
  • Weakened immune system — conditions like HIV/AIDS or immunosuppressive therapies increase vulnerability.
  • Previous radiation therapy — especially in the abdominal region, may contribute to tumour formation.

How is a small bowel tumour diagnosed?

Diagnosing a small bowel tumour requires a combination of advanced medical expertise and diagnostic tools. At Colorectal Care Specialists (CRCS), we utilise a comprehensive approach to ensure accurate and timely identification of small bowel tumours, so that we can offer our patients the best possible care. Our diagnostic methods include:
  • Endoscopy — procedures like upper endoscopy, capsule endoscopy, and double balloon enteroscopy allow direct visualisation of the small intestine to detect abnormalities.
  • Imaging studies — advanced techniques such as CT scans, MRI, and specialised enterography provide detailed images of the small bowel to identify tumours and assess their extent.
  • Biopsy — tissue samples obtained during endoscopy or imaging-guided procedures help determine the nature of the tumour, whether benign or malignant.
  • Blood tests — these include tests for anaemia or tumour markers that may indicate the presence of a tumour.
  • Barium studies — a traditional yet effective method where X-rays are taken after the patient ingests a barium solution, highlighting abnormalities in the small intestine.
  • PET scans — used to detect cancerous activity and potential spread to other parts of the body.

At Colorectal Care Specialists, we develop diagnostic plans tailored to each patient’s needs, which helps us ensure thorough evaluation and effective treatment strategies.

Doctors use upper endoscopy, capsule endoscopy, and double balloon enteroscopy to diagnose small bowel tumours by directly visualising the intestinal lining for abnormalities.

What are the treatment options for a small bowel tumour in Singapore?

Treating small bowel tumours requires a multidisciplinary approach according to the tumour type, stage, and patient’s overall health. Colorectal Care Specialists (CRCS) provides a comprehensive range of treatment options designed to deliver effective outcomes while prioritising patient comfort and recovery. Our treatment options include:
  • Surgical intervention — surgery is often the primary treatment, and our experienced surgeons perform procedures such as bowel resection to remove tumours while preserving healthy tissue.
  • Targeted therapy — advanced medications that target specific genetic mutations or molecular pathways involved in tumour growth, which helps ensure precise treatment with minimal side effects.
  • Chemotherapy — effective in treating malignant tumours, especially when they have spread or are not entirely removable through surgery.
  • Radiation therapy — used selectively to shrink tumours or alleviate symptoms, particularly for certain types like lymphomas or advanced cancers.
  • Endoscopic procedures — minimally invasive techniques for the removal of small, benign tumours or to address complications such as blockages.
  • Supportive care — nutritional support, pain management, and rehabilitation to enhance recovery and quality of life.

At Colorectal Care Specialists (CRCS), we combine expertise, advanced technology, and care to guide our patients through every step of their treatment journey. If you are experiencing symptoms like persistent abdominal pain, unexplained weight loss, or changes in bowel habits, schedule a consultation with CRCS for a comprehensive diagnosis and personalised treatment plan to address your concerns effectively.

Frequently Asked Questions

The prognosis depends on factors like tumour type, stage at diagnosis, and overall health. Early detection generally leads to better outcomes, with localised diagnoses having a five-year survival rate of approximately 84%. 

Small bowel cancer is relatively rare, accounting for less than 5% of all gastrointestinal cancers. 

Small bowel tumours can be either benign or malignant. Benign tumours include lipomas and leiomyomas, while malignant types encompass adenocarcinomas, carcinoid tumours, lymphomas, and sarcomas.

Yes, malignant small bowel tumours can metastasize to other organs, such as the liver, lymph nodes, and peritoneum (lining of the abdominal and pelvic cavity), especially if not detected and treated early.

If left untreated, small bowel tumours can lead to complications like intestinal obstruction, bleeding, perforation, and malabsorption, which may result in significant health issues.

Recovery time varies based on the surgery’s extent and the patient’s health. Generally, patients may need several weeks to a few months to fully recover, with follow-up care to monitor for recurrence or complications.

Location

Colorectal Care Specialists (CRCS)

3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, Singapore 228510

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