Treatment Choices for Small Intestine Cancer (Adenocarcinoma), Based on Tumor Spread

The treatment of small intestine cancer depends mainly on whether or not the cancer can be removed completely with surgery. Cancers that can be removed completely are called resectable, while those that cannot are called unresectable.

Resectable cancers

Resectable cancers are treated with surgery to remove the cancer and some healthy surrounding tissue. The type of surgery will depend on where the cancer is:

• If the cancer is in the duodenum (the first part of the small intestine), an extensive operation called a Whipple procedure (or pancreaticoduodenectomy) is typically done.
• If the cancer is in another part of the small intestine, a segmental resection (removing the part of the intestine containing the tumor) is more likely to be done.
• If the cancer is near the end of the small intestine, part of the large intestine (colon) might need to be removed as well.

If the cancer has grown through the wall of the intestine or spread to nearby lymph nodes, the doctor may recommend adjuvant chemotherapy (chemo) or radiation therapy after surgery to try to kill any cancer cells that may have been left behind but were too small to see. The hope is that this treatment will help keep the cancer from coming back (recurring). It’s not yet clear if adjuvant treatment can help people with small intestine cancer live longer.

Some doctors are also testing if giving chemo or radiation before surgery (known as neoadjuvant therapy) might be helpful. The hope is that this might shrink the tumor and make surgery easier, but so far it’s not clear how helpful this treatment might be.

Unresectable cancers

A small intestine cancer may be unresectable if it has grown into nearby tissues or if it has spread to other organs and tissues  (or if a person isn’t healthy enough for major surgery).

Some people with unresectable cancers still have surgery to treat blocked intestines. This might include removing a large part of the tumor, or bypassing the tumor in some way. This type of palliative surgery can often help prevent or relieve symptoms like nausea, vomiting, and abdominal pain.

Whether or not surgery is done, chemotherapy is typically part of treatment. If the cancer is in the lining of the abdomen, chemo might be given right into the abdominal space just after surgery (known as intraperitoneal chemotherapy). Radiation therapy can also be used to treat cancer that has spread, especially to the brain or bones (such as the spine).

Another treatment option for some people might be immunotherapy, which uses medicines to boost the body’s own immune response against the cancer. For people whose cancer cells have certain gene changes, such as mismatch repair (MMR) gene mutations or microsatellite instability (MSI), treatment with medicines called checkpoint inhibitors, such as pembrolizumab (Keytruda), might be helpful.

Because there is no generally accepted standard treatment for these advanced cancers, taking part in a clinical trial is also a good option.