Surgery for Small Intestine Cancer (Adenocarcinoma)

Surgery is typically the main treatment for small intestine cancer. For some people, t might be the only treatment they need. At this time, surgery is the only treatment that can cure a cancer of the small intestine.

When might surgery be used?

• For people whose cancer is only in or near the place where it started (that is, in the small intestine and perhaps nearby organs), surgery is typically done to try to remove all of the cancer.
• If the cancer has spread too far to be removed completely, surgery might be done to help prevent or relieve problems that could be caused by the tumor growing large enough to block the intestine (or other problems).

The type of operation will depend on a number of factors, including the size and location of the tumor, and whether a person has any serious health problems.

Segmental resection

This operation removes (resects) the segment of intestine that has the tumor, as well as some of the normal tissue on either side of the tumor. The 2 cut ends of intestine are then attached back together. Some nearby tissue containing lymph nodes is also removed. Tumors in the end of the ileum (the last part of the small intestine) may require removing the right side of the colon (the first part of the large intestine). This surgery is called a hemicolectomy.

Usually this surgery is done through a long cut made in the abdomen. Another option for some smaller cancers might be “keyhole” (laparoscopic) surgery, in which the operation is done through several small cuts using long, thin surgical tools.

After surgery, it can take a few days before a person can eat and drink normally. Removing a small piece of intestine usually doesn’t cause long-term problems with eating or bowel movements, but there are more likely to be issues if part of the colon is removed as well.

Pancreaticoduodenectomy (Whipple procedure)

This extensive operation can be used to treat cancers of the duodenum (the first part of the small intestine), although it is more often used to treat pancreatic cancer. It 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 then attached to the small intestine so that bile from the liver can continue to enter the small intestine.

This is a complex operation that carries a fairly high risk of complications, which can sometimes even be fatal. Because of this, it’s important that it is done by a surgeon (and at a center) that has a lot of experience with it. Still, even in the best hands, many patients have side effects from the surgery. These can include:

• Leaking from the various connections that the surgeon has to make
• Infections
• Bleeding
• Trouble with the stomach emptying itself after eating
• Trouble digesting some foods
• Changes in bowel habits
• Significant weight loss

Palliative surgery

If the cancer can't be removed completely because it has spread too far, surgery might still be a good option to help prevent or relieve some symptoms from the cancer. This is known as palliative surgery. Often, these operations are done to relieve a blocked intestine, to decrease pain, nausea, and vomiting, and allow the patient to eat normally.

If possible, the surgeon will remove enough of the tumor and nearby intestine to allow digested food to pass through.

Bypass surgery: Another option might be for the surgeon to leave the tumor in place and to reroute normal parts of the small intestine around the tumor to prevent or relieve a blockage.

Stent or tube placement: If major surgery isn’t a good option for some reason, sometimes an endoscope can be used to pass a fairly rigid tube (called a stent) down the digestive tract and into the blocked part of the intestine. The stent is left in place to help keep the intestine open and allow digested food to pass.

If this can’t be done, a thin, flexible tube may be placed through the skin and into the stomach to drain it. The tube can be left in place to help prevent problems with nausea and vomiting.