Small Bowel Cancer
Adenocarcinoma, neuroendocrine tumors and other rare cancers of the small intestine
Cancer of the small intestine is rare, which means many physicians see only a handful in a career and diagnosis is often delayed. Dr. Papenfuss treats the full range of small bowel tumors, from adenocarcinoma to neuroendocrine tumors, with surgery tailored to the tumor type and location. His Milwaukee practice serves patients from across Wisconsin.
What it is
The small intestine runs about twenty feet from the stomach to the colon, in three parts: the duodenum, jejunum and ileum. Despite its length, cancer here is far less common than in the colon. The main types:
Adenocarcinoma, most often in the duodenum, and more common in people with Crohn's disease, celiac disease or inherited polyp syndromes.
Neuroendocrine tumors (carcinoid), most often in the ileum, frequently slow-growing but with a tendency to spread to lymph nodes and liver. Some release hormones that cause flushing and diarrhea.
GIST and lymphoma, covered separately; GIST has its own page on this site.
Symptoms are vague: cramping, bloating, anemia from slow bleeding, or a blockage. Many are found on CT or capsule endoscopy after months of symptoms.
How it is treated
Segmental resection of the involved bowel with its lymph nodes, often performed robotically or laparoscopically. For neuroendocrine tumors, careful removal of the lymph nodes along the mesenteric vessels is important even when the tumor itself is small.
Whipple procedure for adenocarcinoma of the duodenum near the pancreas.
Chemotherapy after surgery for node-positive adenocarcinoma, and sometimes before for larger tumors.
Liver-directed treatment for neuroendocrine tumors that have spread to the liver, including resection, ablation and histotripsy, since controlling liver disease can control symptoms for years.
Somatostatin analogs and PRRT (a targeted radiation therapy) for advanced neuroendocrine disease, through medical oncology and nuclear medicine.
Dr. Papenfuss's approach
Because small bowel cancers are rare and varied, each case is reviewed with pathology, medical oncology and, for neuroendocrine tumors, endocrinology and nuclear medicine. Dr. Papenfuss performs the full range of operations from robotic segmental resection to Whipple, and manages neuroendocrine liver metastases within the combined HPB program.
When to get a second opinion
If your diagnosis took months, or if you have a neuroendocrine tumor and the plan does not include lymph node removal or a liver evaluation, ask for a review. A records review can happen before you travel.
Call 414-649-3240 to request a consultation.
This page is general information, not medical advice for any individual patient.