Surgery is the main treatment for small intestine cancer and it is often the only treatment. At this time, surgery is the only treatment that can cure a cancer of the small intestine. The type of operation will depend on a number of factors, including the size and location of the tumor, and whether the patient has any serious diseases of other organs.
Resection:Usually this surgery is done through a cut made in the abdomen. This operation removes the piece of intestine that has the tumor and some of the normal tissue on either side of the tumor. The 2 cut ends of intestine are then sewn back together. Some nearby tissue containing lymph nodes will also be removed. After surgery, it can take a few days before the patient can eat and drink normally. Removing a small piece of intestine usually doesn't cause long-term problems with eating or bowel movements.
Pancreaticoduodenectomy (Whipple procedure):This operation is used to treat cancers of the duodenum, although it is more often used to treat pancreatic cancer. It removes the duodenum, part of the pancreas, nearby lymph nodes and part of the stomach. The gallbladder and part of the common bile duct are removed and the remaining bile duct is attached to the small intestine so that bile from the liver can continue to enter the small intestine.
This is a complex operation that requires a lot of skill and experience. It carries a relatively high risk of complications that could even be fatal. When the operation is done in small hospitals or by doctors with less experience, more than 15% of patients may die as a result of surgical complications. In contrast, when this operation is performed in cancer centers by surgeons experienced in the procedure, less than 5% of patients die as a direct result of complications from surgery. In general, people having this type of surgery do better when it is performed at a hospital that does at least 20 of these surgeries per year. Still, even in the best hands, many patients suffer complications 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. Most, if not all, patients who have this surgery lose a lot of weight.
Palliative surgery:If the cancer cannot be completely removed because it has spread too far in the abdomen, the surgeon may do an operation to help improve some of the symptoms that the cancer is causing. This is known as a palliative operation. Often, these surgeries are meant to relieve a blocked intestine, to decrease pain, nausea, and vomiting, and allow the patient to eat normally for some time. If possible, the surgeon will remove enough of the tumor and nearby intestine to allow digested food to pass through.
Sometimes, the surgeon will leave the tumor in place and route the normal small intestine around the tumor so that any blockage is relieved or prevented.
In very advanced situations, a fairly rigid tube (called a stent) is passed through the blocked area and left in place so digested food can pass. If this can’t be done, a tube may be placed in the stomach to drain it and decrease problems with nausea and vomiting.
Chemotherapy for small intestine adenocarcinoma
Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or a muscle or taken by mouth to kill cancer cells. Because these drugs enter the bloodstream and can reach cancer cells anywhere in the body, this treatment can be useful for cancers that have metastasized (spread). But small intestine adenocarcinoma does not seem to be very sensitive to chemotherapy. This is why chemo is not often part of the main treatment for this cancer. Instead, it may be used when the cancer has spread to other organs.
When chemo is given after the tumor is removed with surgery, it is called adjuvant treatment. In this setting, the chemo is meant to get rid of the cancer cells that are left after surgery (but that are too small to see). This lowers the chance that the cancer will come back later. Adjuvant chemo is often used for colon cancer, but it is not known if it works as well for small intestine cancer.
Some of the chemo drugs that can be used include: capecitabine (Xeloda®), 5-fluorouracil (5-FU), oxaliplatin, and irinotecan (Camptosar®, CPT-11). 5-FU is often given with a vitamin-like drug called leucovorin, which helps it work better.
Because small intestine cancer is rare, only a small number of patients have been treated with chemo. This makes it hard to know which drugs work best. Some of the drug combinations that seem to work in advanced small intestine cancer include capecitabine and oxaliplatin (called CAPOX), 5-FU and leucovorin with oxaliplatin (FOLFOX), and 5-FU and leucovorin with irinotecan (FOLFIRI). Oncologists often use combinations that are used to treat colon or stomach cancer.
Chemo drugs kill cancer cells but also damage some normal cells, causing some side effects. Your health care team will pay careful attention to try and avoid or lessen side effects. These depend on the type of drugs, amount taken, and length of treatment. Common temporary side effects might include: Nausea and vomiting, Loss of appetite, Loss of hair, Mouth sores, Low blood counts.
Chemotherapy can damage the blood-producing cells of the bone marrow, so you may have low blood cell counts. This can lead to:
An increased risk of infection (caused by a shortage of white blood cells)
Bleeding or bruising after minor cuts or injuries (caused by a shortage of blood platelets)
Fatigue (tiredness) or shortness of breath (caused by low red blood cell counts)
Other side effects that may occur depend upon the specific drugs used. For example, 5-FU and irinotecan often cause diarrhea. Capecitabine can cause painful reddening of the hands and feet (known as hand-foot syndrome). Oxaliplatin can damage nerves (called neuropathy) leading to numbness, tingling, or even pain in the hands and feet. This can last a long time or even be permanent. Oxaliplatin can also affect nerves in the throat, causing pain that is much worse when trying to eat or drink cold liquids or foods. This pain can lead to trouble swallowing or even breathing, and can last a few days after treatment.
Radiation therapy for small intestine adenocarcinoma
Radiation therapy uses high-energy radiation to kill cancer cells. Radiation therapy may be an option for those whose cancer cannot be removed with surgery and is causing symptoms − for example if a particular spot is painful because of the cancer.
External-beam radiation therapy is the type of radiation used most often for most types of gastrointestinal cancer. It is like having a regular x-ray except it takes longer and involves much higher amounts of radiation. Patients typically have treatments 5 days a week for several weeks. Radiation therapy is used primarily to treat pain from cancer that has spread to the bones or other parts of the body.
The main side effects of radiation therapy to the stomach and intestines include fatigue (tiredness), nausea, vomiting, diarrhea, and mild temporary, sunburn-like skin changes.
If treatment for small intestine adenocarcinoma stops working
If cancer keeps growing or comes back after one kind of treatment, it is possible that another treatment plan might still cure the cancer, or at least shrink it enough to help you live longer and feel better. But when a person has tried many different treatments and the cancer has not gotten any better, the cancer tends to become resistant to all treatment. If this happens, it's important to weigh the possible limited benefits of a new treatment against the possible downsides. Everyone has their own way of looking at this.
This is likely to be the hardest part of your battle with cancer − when you have been through many medical treatments and nothing's working anymore. Your doctor may offer you new options, but at some point you might need to consider that treatment is not likely to improve your health or change your outcome or survival.
If you want to continue to get treatment for as long as you can, you need to think about the odds of treatment having any benefit and how this compares to the possible risks and side effects. In many cases, your doctor can estimate how likely it is the cancer will respond to treatment you are considering. For instance, the doctor may say that more chemo or radiation might have about a 1% chance of working. Some people are still tempted to try this. But it is important to think about and understand your reasons for choosing this plan.
No matter what you decide to do, you need to feel as good as you can. Make sure you are asking for and getting treatment for any symptoms you might have, such as nausea or pain. This type of treatment is called palliative care.
Palliative care helps relieve symptoms, but is not expected to cure the disease. It can be given along with cancer treatment, or can even be cancer treatment. The difference is its purpose - the main purpose of palliative care is to improve the quality of your life, or help you feel as good as you can for as long as you can. Sometimes this means using drugs to help with symptoms like pain or nausea. Sometimes, though, the treatments used to control your symptoms are the same as those used to treat cancer. For instance, radiation might be used to help relieve bone pain caused by cancer that has spread to the bones. Or chemo might be used to help shrink a tumor and keep it from blocking the bowels. But this is not the same as treatment to try to cure the cancer.
At some point, you may benefit from hospice care. This is special care that treats the person rather than the disease; it focuses on quality rather than length of life. Most of the time, it is given at home. Your cancer may be causing problems that need to be managed, and hospice focuses on your comfort. You should know that while getting hospice care often means the end of treatments such as chemo and radiation, it doesn't mean you can't have treatment for the problems caused by your cancer or other health conditions. In hospice the focus of your care is on living life as fully as possible and feeling as well as you can at this difficult time. You can learn more about hospice in our document called Hospice Care.
Staying hopeful is important, too. Your hope for a cure may not be as bright, but there is still hope for good times with family and friends − times that are filled with happiness and meaning. Pausing at this time in your cancer treatment gives you a chance to refocus on the most important things in your life. Now is the time to do some things you've always wanted to do and to stop doing the things you no longer want to do. Though the cancer may be beyond your control, there are still choices you can make.
What’s new in small intestine adenocarcinoma research and treatment?
There is always research going on in the field of gastrointestinal (GI) cancer. Scientists are looking for the causes of these cancers, as well as ways to prevent, and treat GI cancers. Small intestine adenocarcinoma is studied less often than some of the other GI cancers because it is so rare. Still, recent studies have looked at ways to treat this cancer with vaccines, chemotherapy, and surgery. Also, studies of patients with colon cancer other GI cancers may prove useful for people with small intestine adenocarcinoma. These studies involve early detection, drug treatment, surgical methods, and understanding the cause of these cancers.
Most small intestine cancers look very similar to colon cancers under a microscope, but detailed studies of the chromosomes and DNA in their cancer cells have found some differences. Researchers hope that these results, as well as other research into the molecular changes in small intestine adenocarcinomas will eventually lead to more effective treatments.