Treatment for small bowel cancer
Your treatment will depend on what type of small bowel cancer you have. This page is about the treatment you might have if you have small bowel adenocarcinoma. This is the most common type of small bowel cancer.
Treatment for other types of small bowel cancer, such as neuroendocrine cancer and lymphoma will be different.
Deciding which treatment you need
Your doctor will talk to you about the treatment they suggest. They will explain its benefits and the possible side effects.
Your treatment will depend on:
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where your cancer is
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how big it is and whether it has spread (the stage)
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how abnormal the cells look under a microscope (the grade)
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your general health and level of fitness
Treatments can include:
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surgery
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radiotherapy
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chemotherapy
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immunotherapy
If your cancer hasn't spread to other parts of the body
You will probably have 
if your cancer hasn’t spread and you are fit enough. Your surgeon removes the cancer along with a clear border of tissue around it. They also remove the nearest lymph nodes.
Having after surgery (adjuvant treatment) might help to reduce the risk of your cancer coming back, especially if your cancer began in the duodenum. But more evidence is needed into the benefits of adjuvant chemotherapy.
If your cancer has spread nearby, you might not be suitable for surgery. But your doctor might recommend chemotherapy at first and then depending on how you respond you might have surgery afterwards.
If your cancer has spread to other parts of the body
Treatment options include:
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surgery to relieve a blocked bowel
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unblocking the bowel with a tube called a stent
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chemotherapy
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radiotherapy
Treatment
Surgery to remove the cancer
The type of surgery you have to remove the cancer depends on where the cancer is in the small bowel.
You are most likely to have a type of surgery called wide excision.
In a wide excision, your surgeon will remove the:
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cancer
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surrounding tissues
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lymph nodes
But for cancer in the top of the duodenum you might have a pancreaticoduodenectomy. The surgeon removes:
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part of your pancreas
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your gallbladder
The surgeon also might remove part of your stomach.
For cancer on the side of your (distal) ileum the surgeon might also remove part of your large bowel.
Surgery for bowel obstruction
Sometimes cancer can grow so that it completely blocks the bowel. This is called a bowel obstruction. The waste from the food you have digested can't get past the blockage.
To relieve symptoms, it is sometimes possible to:
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unblock the bowel by putting in a tube called a stent
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remove the blocked section of bowel
After removing the part of bowel with the cancer, your surgeon will join the two ends of the remaining bowel together. You might need an if this is not possible or if there is a high risk of there being a complication with the join. This is when part of the small bowel is brought up onto the surface of the abdomen to form a .
You wear a special bag over the stoma to collect your bowel movements (faeces).
Chemotherapy
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
You might have chemotherapy to reduce or control symptoms of cancer that has spread.
You might have:
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fluorouracil (5FU)
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folinic acid, fluorouracil and oxaliplatin (FOLFOX)
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oxaliplatin and capecitabine (CAPOX)
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folinic acid, fluorouracil and irinotecan (FOLFIRI)
Radiotherapy
Radiotherapy uses high energy rays to destroy cancer cells.
Radiotherapy isn’t used much for small bowel cancer. It is mainly used to treat metastatic small bowel cancers. Metastatic cancer means that the cancer has spread to another part of the body.
Small bowel cancer may have spread either when it is diagnosed or if it comes back after treatment. Radiotherapy can help to control symptoms you have because of metastatic cancer, such as pain.
Immunotherapy
Immunotherapy uses our immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells. Pembrolizumab is a type of immunotherapy.
You might have pembrolizumab your cancer has changes that mean it is called:
mismatch repair deficient (MMRd)- high
microsatellite instability (MSI high)
It is for people who have cancer that has spread, or cannot be removed with surgery, and who have tried at least one other treatment before.
Research into small bowel cancer treatment
Finding out how well treatments work when a cancer is rare is difficult. It is harder to organise trials because there are fewer people that can take part. This means it takes longer to get meaningful results.
Researchers are interested in:
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whether chemotherapy after surgery can improve survival
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comparing different cancer drugs
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how immunotherapy can help people with small bowel cancer
Coping
Coping with a diagnosis of a rare cancer can be especially difficult. Being well informed about your cancer and its treatment can help. It can make it easier to make decisions and cope with what happens.
Talking to other people who have the same thing can also help.
Our discussion forum Cancer Chat is a place for anyone affected by cancer. You can share experiences, stories and information with other people.
You can call our nurse freephone helpline on 0808 800 4040. They are available from Monday to Friday, 9am to 5pm. Or you can send them a question online.
The Rare Cancer Alliance offer support and information to people with rare cancers. It has a forum where you might be able to meet others with the same cancer as you.
