The Small Intestine is Not the Colon!

When J was diagnosed with cancer of the small intestine (or small bowel), I immediately hit the stacks to find out just exactly what is the small intestine’s function in our digestive system.

We did know a little about the small intestine before J’s diagnosis because his father was diagnosed with the exact same cancer almost 30 years before. But our memory was foggy, and we needed to know more. Besides, 30 years ago we couldn’t research it on the internet. I remember calling our friend in medical school and having him look up J’s dad’s cancer in his big “doctor’s book”. He gave us the overall stats and basic recommended treatments and shared his general knowledge of the small intestine’s function (and malfunction) over the phone, but that’s about it. There was no opportunity to sit down at a computer and spend days researching a diagnosis back then. In some ways, it sounds easier and almost quaint: the patient relied fully on the doctor’s diagnosis and treatment recommendations, and s/he didn’t feel overwhelmed by all the details and options. On the other hand, it sounds like a terribly restrictive and passive role for the patient and family members to play. How could a patient ask pertinent questions and engage in meaningful dialogue with the doctors if his or her knowledge was so limited? Where were the checks and balances, so to speak, on the doctor-patient relationship? I guess I’d choose to be overwhelmed by information than lacking it.

Most people, including yours truly, have heard a lot more about colon cancer than small intestinal or small bowel cancer. In fact, there’s an article on the front page of the Washington Post just today about the increased incidence of colon cancer in people younger than 50. Most people (except those in my husband’s family) are a lot more likely to be diagnosed with colon cancer than they are with small bowel cancer, that’s for sure. To understand the difference between these two cancers, let’s compare and contrast the functions and form of the small intestine versus the large intestine.

The small intestine (duodenum, jujunem and ileum) may be small in diameter (about the size of a middle finger), but it makes up for it in length–around 22 ft. By contrast, the large intestine is bigger in diameter, but only about 5-6 ft in length. Not only is it longer, but the small intestine outshines the large intestine in nutritional importance, too. In fact, over 90% of the digestion and absorption of food, including nutrients and minerals, occurs in the small intestine, with the other measley 10% taking place in the stomach and the large intestine. Therefore, I propose we rename the small intestine the really long really important nutrient powerhouse intestine! So anyway, how come we hear about the stomach and the large intestine so much more than the small aka really long really important nutrient powerhouse intestine? I don’t have an answer to that! But here’s more of what we do know: in order for all 22 ft of the small intestine to fit inside the gastrointestinal tract, it has to be packed in there pretty tightly. I guess that’s one of the many reasons why small intestinal disorders, including cancer, often prove to be so difficult to diagnose. That, and the fact that there are about a jillion different diagnoses for the same gastrointestinal symptoms.

Real tip #1: If you have part of your small intestine removed, particularly your ileum and/or ileocecal valve, check with your doctor to see if you need to take vitamins or other nutritional supplements. The small intestine is a nutrient powerhouse, so if you’re missing part of it, you might be missing out on some vital nutrients and vitamins, such as B12, iron or folate!

Food sits in the small intestine much longer than it does in the large intestine, due, in part to the many circular folds and villi that slow down the movement of the food through the small intestine. The small intestine, with the help of the pancreas, produces enzymes that aid in the digestion of food.

As for the large intestine, it absorbs water and salts from food that has not yet been digested and it eliminates leftover waste.

Here’s another pretty important distinction between the small intestine and the large intestine that I’ve learned:

YOU CAN LIVE WITHOUT YOUR LARGE INTESTINE

but…

YOU CAN’T LIVE WITHOUT YOUR SMAll INTESTINE!

That’s a pretty important distinction, is it not? Of course, it’s not easy to live without your large intestine, but it’s possible, and when death is staring you in the face, most people will choose life with health challenges over death, don’t you think? I don’t want to minimize the challenges of living without a colon or large intestine. I’m just saying it is possible to live without one. For more information about that, check out the blog I just discovered entitled inflamed-and-untamed that documents, among other things, the challenges of living without a colon.

Real tip #2: You can’t live without your small intestine! Appreciate your small intestine! #prettyimportant #smallintestine

For an explanation of the difference in the term colon versus large intestine, I suggest you look no futher than here for snazzy diagrams and easy to understand graphics and here for a straight-up explanation. In a nutshell, the colon is part of the large intestine. The colon consists of 4 sections: ascending colon, transverse colon, descending colon and sigmoid colon. The large intestine includes all four of those sections PLUS the cecum (the part that connects to the small intestine’s ileum), the appendix, the rectum, and the anal canal. But in everyday language, most people don’t know the difference between the large intestine and the colon and use the terms interchangeably. But if you want to sound smart when you ask your oncologist questions, you might want to memorize the differences! :0)

Real tip #3: The appendix is part of the large intestine! Who knew? #ihopemydoctorknew

According to livescience.com approximately 9,000 cases of small intestinal cancer are diagnosed per year, and according to ccalliance.org there are about 137,000 cases of colon cancer diagnosed per year. And while I’m mentioning this, I should also encourage you to get a colonoscopy because they really do detect colon cancer and save lives! They’re not as effective at helping diagnose small intestine, but they do sometimes speed up the process.

The statistics show how much more common colon cancer is than small bowel cancer, and yet, during J’s treatment, our beloved oncologist, Dr. C, would admit that given the scant data on small intestinal cancer, J’s treatment protocol was partly and sometimes even largely based on colon cancer research. Not the most reassuring bit of news, but at least he was honest.

Real tip #4: Colon cancer is way more common than small intestine cancer. Screenings help detect it, too, so get your colonoscopy! #colonoscopy #colon #colonoscopiessavelives

Here’s to our federal government and other organizations funding more research into rare cancers, such as cancer of the small intestine or small bowel! And in J’s case, we’d particularly like to see more research into small intestinal cancer that originates in the ileum!