Small Intestine Cancer Treatment and Survival Rate

November 22, 2024

This page was reviewed under our medical and editorial policy by Laleh Melstrom, M.D., M.S., associate professor of surgery and immuno-oncology, Division of Surgical Oncology, Department of Surgery, City of Hope^® Cancer Center Duarte

For people diagnosed with small intestine cancer, individualized treatment plans are important because they take into account personal factors like the cancer’s type and stage, the patient’s age, overall health, and treatment preferences and responses (including side effects).

This rare form of cancer — which is sometimes called small bowel cancer or small bowel adenocarcinoma — is commonly treated with the same therapies used to treat colon cancer, although doctors may alter dosing and treatment schedules. A patient’s health care team includes cancer doctors (oncologists), nurses, pharmacists and support counselors who focus on each individual’s needs and work together to provide personalized, advanced cancer care.

Treatment for Small Intestine Cancer

Treatment for small intestine cancer may include one or a combination of therapy options.

Doctors first determine if the cancer may be removed completely by surgery. This is known as resectable cancer. Cancer that is unable to be fully removed by surgery is called unresectable cancer. In both cases, a number of chemotherapy and radiation therapy options are available for use before, after or, sometimes, instead of surgery.

Surgery

As the most common treatment for small intestine adenocarcinomas, surgery is performed to remove all or most of the cancer. Sometimes it is performed to remove blockages in the small intestine caused by the tumor, in order to relieve discomfort.

The following are the three main types of small bowel cancer surgery.

Segmental resection: Resect means to cut out or remove. In this type of surgery, the area of the small intestine where the tumor sits is removed and the remaining sections are joined together. The surgery may be performed using small incisions in the abdomen and a laparoscope (a surgical tool with a lens attached), or by making one large incision. The doctor who performs the procedure, known as a surgical oncologist, may also remove surrounding tissues, lymph nodes and part of the large intestine (hemicolectomy) if the tumor is close to it.

After a small intestine resection, the most common side effects are infections, fistulas (abnormal connections between parts of the body) and leaks where the attachments were made.

Whipple procedure (pancreaticoduodenectomy): The duodenum is the part of the small intestine that connects to the stomach. If cancer is located in this area, a Whipple procedure may be recommended. During this complex procedure, the surgeon removes the duodenum, along with the gallbladder, nearby lymph nodes and parts of the stomach, pancreas and common bile duct. The remainder of the bile duct is then joined to the small intestine to ensure that bile (which digests fat) reaches it.

Whipple procedures may include the following side effects:

• Leaks at surgical connection sites
• Bleeding
• Infections
• Digestion issues
• Weight loss
• Bowel movement changes

Palliative surgery: Even if cancer has spread beyond the small intestine and is unable to be removed completely through surgery, patients with symptoms such as pain, discomfort, vomiting and nausea may still benefit from palliative surgeries. These are procedures to remove or bypass tumors (by rerouting the intestine around it) that may be blocking digestion. A rigid tube called a stent may also be placed into the intestine using a surgical tool called an endoscope that is inserted through the throat and esophagus. The endoscope has an attached camera and light to help the doctor properly place the stent, allowing food to pass through it. 

While palliative surgery may also have some side effects, such as pain, diarrhea, constipation, infection and bleeding, its goal is to alleviate discomfort caused by the tumor.

Chemotherapy

Chemotherapy for small intestine cancer is typically used in combination with surgery, especially if the cancer has spread through the small intestine wall or to other body parts. Drugs such as Xeloda^® (capecitabine), Eloxatin^® (oxaliplatin), Camptosar^® (irinotecan), and Carac^®, Tolak^®, Efudex^® or Fluoroplex^® (5-fluorouracil) help destroy small intestine cancer cells.

Sometimes these chemotherapy drugs are given together to maximize their effects. They may be delivered by intravenous (IV) infusion, by mouth or topically.

The types of chemotherapy used for small bowel cancer include adjuvant chemotherapy and intraperitoneal chemotherapy.

Adjuvant chemotherapy: Sometimes referred to as preventive chemotherapy, this is used after surgery to help destroy any potential remaining cancer cells and help prevent the cancer from coming back. A form of chemotherapy that is given before surgery, called neoadjuvant chemotherapy, is also being tested to see if it may help shrink small bowel tumors and make surgery more successful.

Intraperitoneal chemotherapy: If cancer has spread beyond the small intestine to the abdominal lining (peritoneum), chemotherapy drugs may be placed directly into the abdomen after surgery. Heating the drugs is known as hyperthermic intraperitoneal chemotherapy, and it may make the treatment more successful.

People taking chemotherapy may experience several side effects, including:

• Low blood cell counts that may increase the risk of infections, bruising, bleeding, fatigue and breathing
• problems
• Loss of appetite
• Hair loss
• Nausea and vomiting
• Sores in the mouth
• Diarrhea
• Numbness, pain, tingling, swelling or redness of the hands or feet
• Sensitivity to heat and cold, especially in the throat and esophagus

Often, these side effects stop after treatment ends, although hand and foot issues may linger. Prescription medications may sometimes be used to help ease these effects.

Radiation Therapy

High-energy waves used to shrink tumors and destroy cancer cells are known as radiation therapy. Similar to chemotherapy, adjuvant radiation therapy may be used after surgery to help destroy any potential remaining cancer cells. In addition, if the cancer is unable to be removed completely (unresectable), the surgeon may recommend radiation therapy to help reduce issues caused by the tumor, such as intestinal bleeding and pain.

External-beam radiation is the main type of radiation therapy used to treat small intestine cancer. In this treatment, radiation beams are aimed at the cancer cells from outside the patient’s body using a machine. Imaging tests, such as computed tomography (CT) or magnetic resonance imaging (MRI) scans, may be performed prior to or along with this treatment to help pinpoint the tumor’s location and determine the appropriate angles to use when aiming the radiation beams.

There are several types of external-beam radiation, and the treatment is typically performed as an outpatient procedure at a hospital or clinic.

The most common side effects of radiation therapy include:

• Nausea and vomiting
• Diarrhea
• Fatigue
• Red, peeling or blistering skin where the radiation beams were aimed

Small Intestine Cancer Survival Rate

A person’s chance of recovery or cancer recurrence is known as a prognosis.

The prognosis for cancer in the small intestine is tied to a number of personal factors, including a patient’s response to cancer treatments, his or her age and overall health at the time of diagnosis, and how far the cancer has spread (its stage). In addition, new treatments may be developed to improve the outlook for the disease.

One way to gauge prognosis is the five-year relative survival rate. This is a statistical estimate of a patient’s chance of surviving five years or more after their diagnosis. It is based on patients in the past and does not take into account advances in treatment.

Overall, the five-year relative survival rate for people diagnosed with small intestine adenocarcinoma between 2015 and 2021 was 71.1%, according to the National Cancer Institute. This survival rate varied by the cancer’s stage, as follows.

• Localized (within the small intestine walls): 85.6%
• Regional (spread to nearby tissue or lymph nodes): 79.6%
• Distant (spread to distant organs or structures): 46.6%

Survival rates for the disease may also be affected by age. According to the National Cancer Institute, the overall small intestine cancer five-year relative survival rate between 2000 and 2021 was 59.5% for those aged 65 and older, 74.2% for those between 50 and 64 years of age, and 79.3% for those under age 50.

Small Intestine Cancer Treatment at City of Hope

Small intestine cancer is quite rare, making it even more important to find a health care team that is familiar with this type of cancer and has expertise about the best and most individualized treatments.

City of Hope’s approach to cancer care is centered on precision medicine. That means every aspect of a patient’s care is tailored to his or her specific cancer. Our cancer care specialists apply precise and minimally invasive surgical techniques, and test individual cancer cells to find drug combinations and therapies suited to each patient’s specific case.