Small Bowel Cancer: Types of Treatment

Approved by the Cancer.Net Editorial Board, 07/2021

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with small bowel cancer. Use the menu to see other pages.

This section explains the types of treatment that are the standard of care for small bowel cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How small bowel adenocarcinoma is treated

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary teamCancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

The common types of treatments used for small bowel cancer are described below. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for small bowel cancer because there are different treatment options. Learn more about making treatment decisions.

Small bowel adenocarcinomas are uncommon, so there is limited scientific research on what the best treatment options are. Because small bowel adenocarcinomas are similar to colon cancers, they are often treated with the same treatments as colon cancer. Not all of the treatments described below have received approval from the U.S. Food and Drug Administration (FDA) for the treatment of small bowel adenocarcinoma. Be sure to talk with your doctor about your treatment options and plan. This discussion should include whether there are clinical trials for small bowel adenocarcinomas available for you.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is the most common treatment for small bowel cancer. A surgical oncologist is a doctor who specializes in treating cancer using surgery.

Surgery may be used to remove the tumor and the affected part of the small intestine, join the bowel back together, and/or bypass an obstruction (blockage) of the small bowel. Lymph nodes may also need to be removed to find out the risk of the cancer spreading.

There is a risk that some cancer cells may remain in the body and spread after surgery, even with stage I to stage III disease. This is why the doctor may recommend another type of treatment, such as chemotherapy, given after surgery to lower this risk. This kind of treatment is called adjuvant therapy (see "Therapies using medication," below).

Depending on the extent of surgery, it may be necessary to follow a special diet with medicines and supplements to help your digestion. Other side effects of surgery may include pain and tenderness in the area of the operation. The operation may also cause constipation or diarrhea, which usually goes away after some time. Talk with your health care team about the possible side effects of your surgery, including what to expect during your recovery. This should include how you can eat well and maintain nutrition during and after treatment.

Learn more about the basics of cancer surgery.

Therapies using medication

Treatments using medication are used to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This type of medication is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications, be sure to ask your health care team about how to safely store and handle it.

The types of medications used for small bowel cancer include:

  • Chemotherapy

  • Immunotherapy

  • Targeted therapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A patient may receive 1 drug at a time or a combination of different drugs at the same time. Chemotherapy is sometimes given after surgery as adjuvant therapy in the treatment of small bowel adenocarcinoma (see "Surgery," above). It can also be prescribed to relieve side effects for people with advanced cancer. Common regimens for small bowel adenocarcinoma include:

  • Fluorouracil (5-FU)/leucovorin (folinic acid)

  • FOLFOX: 5-FU with leucovorin and oxaliplatin (Eloxatin)

  • FOLFIRI: 5-FU with leucovorin and irinotecan (Camptosar)

  • CAPEOX: Capecitabine (Xeloda) with oxaliplatin

  • Capecitabine: An oral form of 5-FU

  • FOLFOXIRI: 5-FU, leucovorin, oxaliplatin, irinotecan

  • Bevacizumab (Avastin, which is a "targeted therapy," see below) may be combined with a chemotherapy regimen to treat metastatic small bowel adenocarcinoma.

Unlike colon cancer, some studies for small bowel adenocarcinoma have shown a benefit to using taxane-based chemotherapy regimens, such as paclitaxel (available as a generic drug), docetaxel (Taxotere), and nab-paclitaxel (Abraxane), either as a single drug or in combination with either gemcitabine (Gemzar) or carboplatin (available as a generic drug).

If surgery is not possible, the doctor may recommend chemotherapy to shrink the tumor to the point where it can be surgically removed. This is called neoadjuvant therapy. Sometimes, chemotherapy combined with radiation therapy may be recommended for neoadjuvant therapy. This is called chemoradiation.

Chemotherapy affects normal cells as well as cancer cells, so many people experience side effects from this treatment. The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Talk with your health care team about the specific chemotherapy prescribed for you and what side effects are possible, including how they can be relieved or managed.

Learn more about the basics of chemotherapy.

Immunotherapy (updated 09/2021)

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Examples of immunotherapy include cancer vaccines, monoclonal antibodies, and interferons.

In some people, small bowel adenocarcinoma may have a molecular feature called high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR). Tumors with these features can be treated with a type of immunotherapy called an immune checkpoint inhibitor if the disease has spread to other parts of the body and previous first-line treatment did not work. Immune checkpoint inhibitors that may be used to treat small bowel adenocarcinoma include:

  • Pembrolizumab (Keytruda)

  • Nivolumab (Opdivo)

  • Ipilimumab (Yervoy)

  • Dostarlimab (Jemperli)

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

Targeted therapy for small bowel adenocarcinoma includes:

  • Bevacizumab (Avastin). Bevacizumab is an anti-angiogenesis therapy that stops angiogenesis, which is the process of making new blood vessels. When bevacizumab is used to treat small bowel adenocarcinoma, it is combined with chemotherapy (see above).

  • Tumor-agnostic treatment. Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) are types of targeted therapy that are not specific to a certain type of cancer but focus on a specific genetic change called an NTRK fusion. This type of genetic change is rare but is found in a range of cancers, including small bowel adenocarcinoma. It may be used to treat metastatic cancer.

Talk with your doctor about possible side effects for a specific medication and how they can be managed.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.

Radiation therapy is not often used as the primary treatment for small bowel cancer. But it may be combined with chemotherapy, called chemoradiation, to shrink tumors with the goal of making surgery possible (see above). It is more commonly used as a palliative treatment (see below) to help relieve side effects.

The most common type of radiation treatment is called external-beam radiation, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

Side effects from radiation therapy include tiredness, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.

Learn more about the basics of radiation therapy.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy. For example, if the cancer has blocked the bowel, then surgery with or without chemotherapy may be used to remove the blockage.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan being recommended. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a seperate section of this website.

Metastatic small bowel cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include a combination of surgery, radiation therapy, chemotherapy, immunotherapy, and targeted therapy. Often, chemotherapy with or without targeted therapy will be the first treatment recommended. If the cancer has a specific molecular feature called MSI-H or dMMR, an immune checkpoint inhibitor may be recommended (see “Immunotherapy,” above) as second-line therapy. Otherwise, a different chemotherapy regimen may be offered. Palliative care will also be important to help relieve symptoms and side effects.

For most people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical TrialsIt offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.