Small Bowel Cancer
Treatment for small bowel cancer
You will be cared for by a multi-disciplinary team (MDT) of health professionals during your treatment for small bowel cancer. These may include a surgeon, radiation oncologist (to prescribe and coordinate a course of radiation therapy), medical oncologist (to prescribe and coordinate a course of drug therapies which includes chemotherapy and immunotherapy), gastroenterologist (to treat disorders of the digestive system), nurse and allied health professionals such as a dietitian, social worker, psychologist or counsellor, physiotherapist and occupational therapist.
Discussion with your doctor will help you decide on the best treatment for your cancer depending on:
- the type of cancer you have
- where it is in your body
- whether or not the cancer has spread (stage of disease)
- your age, fitness and general health
- your preferences.
The main treatments for small bowel cancer include surgery and chemotherapy. Often medications are used that block cancer cells from secreting hormones and chemicals. These treatments can be given alone or in combination.
Surgery is the main treatment for small bowel cancer (adenocarcinoma, sarcoma and neuroendocrine tumours), especially for people with early-stage disease who are in good health. It is not usually recommended for lymphomas in the small bowel – these are commonly treated with radiation therapy and/or chemotherapy.
The way the surgery is done depends on the location and stage of the tumour. Your doctor will advise which approach is most suitable for you.
Open surgery – This involves one long cut down the middle of your abdomen (tummy).
Keyhole surgery – This involves several small cuts in the abdomen. A thin tube with a light and camera (laparoscope) is passed through one of the cuts and long, thin instruments are inserted through other small cuts to remove the cancer.
Resection – Surgical removal of part of the small bowel that contains cancer; surrounding lymph nodes and nearby organs (stomach, large bowel, gall bladder) may also be removed during the procedure.
- Right Hemicolectomy – removes the right side of the large bowel and the end of the ileum.
- Whipple procedure – removes the pancreas, the duodenum, the gall bladder and bile duct. Also called pancreaticoduodenectomy.
Bypass – Surgical connection to allow digested food in the small bowel to go around the cancer if it is blocking the bowel and cannot be removed.
If part of the bowel is removed during surgery, the surgeon will usually join it back together. This join is called an anastomosis. If this isn’t possible, you may need a stoma where the end of the intestine is brought through an opening (the stoma) made in your abdomen to allow faeces to be removed from the body and collected in a bag. This procedure is called an ileostomy if made from the small bowel. The stoma may be temporary (where the operation is reversed later) or permanent if it is not able to be rejoined.
Living with a stoma
If there is a chance you could need a stoma, the surgeon will refer you to a stomal therapy nurse before surgery. Stomal therapy nurses are registered nurses with special training in stoma care. They can answer questions about your surgery and recovery, and give you information about adjusting to life with a stoma. For more details, visit the Australian Association of Stomal Therapy Nurses or call Cancer Council 13 11 20.
Chemotherapy (sometimes just called “chemo”) is the use of drugs to kill or slow the growth of cancer cells. You may have one chemotherapy drug, or a combination of drugs. This is because different drugs can destroy or shrink cancer cells in different ways.
Your treatment will depend on your situation and the type of cancer you have. Chemotherapy is often used to treat lymphomas in the small bowel. Your medical oncologist will discuss your options with you.
Chemotherapy is given through a drip into a vein (intravenously) or as a tablet that is swallowed. It is commonly given in treatment cycles which may be daily, weekly or monthly. For example, one cycle may last three weeks where you have the drug over a few hours, followed by a rest period before starting another cycle. The length of the cycle and number of cycles depends on the chemotherapy drugs being given.
Immunotherapy or biological therapy uses the body’s own immune system to fight cancer. It uses materials made either by the body or in a laboratory to improve immune system function. There are different types of immunotherapy available so talk to your doctor about what might be appropriate for you.
Radiation therapy (also known as radiotherapy) uses high energy rays to destroy cancer cells, where the radiation comes from a machine outside the body. It may be used for small bowel cancer:
- before or after surgery, to destroy any remaining cancer cells and stop the cancer coming back
- if the cancer can’t be removed with surgery
- if the cancer comes back in a limited way, such as only in your abdominal lymph glands.
Radiation therapy can shrink the cancer down to a smaller size. This may help to relieve symptoms such as pain or blood loss.
A course of radiation therapy needs to be carefully planned. During your first consultation session you will meet with a radiation oncologist who will arrange a planning session. At the planning session (known as CT planning or simulation) you will need to lie still on an examination table and have a CT scan in the same position you will be placed in for treatment.
The information from the planning session will be used by your specialist to work out the treatment area and how to deliver the right dose of radiation. Radiation therapists will then deliver the course of radiation therapy as set out in the treatment plan.
Radiation therapy does not hurt and is usually given in small doses over a period of time to minimise side effects.
Your doctor or nurse may suggest you take part in a clinical trial. Doctors run clinical trials to test new or modified treatments and ways of diagnosing disease to see if they are better than current methods. For example, if you join a randomised trial for a new treatment, you will be chosen at random to receive either the best existing treatment or the modified new treatment. Over the years, trials have improved treatments and led to better outcomes for people diagnosed with cancer.
You may find it helpful to talk to your specialist, clinical trials nurse or GP, or to get a second opinion. If you decide to take part in a clinical trial, you can withdraw at any time.
For more information, visit Australian Cancer Trials or the Australasian Gastro-Intestinal Trials Group (AGITG).
For information on sarcoma clinical trials contact the Australia and New Zealand Sarcoma Association (ANZSA).
For information on NET clinical trials contact NeuroEndocrine Cancer Australia.
For information on lymphoma clinical trials contact the Australian Leukaemia and Lymphoma Group (ALLG).
Complementary therapies tend to focus on the whole person, not just the cancer, and are designed to be used alongside conventional medical treatments (such as surgery, chemotherapy and radiation therapy). They can increase your sense of control, decrease stress and anxiety, and improve your mood.
Some Australian cancer centres have developed “integrative oncology” services where evidence-based complementary therapies are combined with conventional treatments to create patient-centred cancer care that aims to improve both wellbeing and clinical outcomes.
Some complementary therapies and their clinically proven benefits are listed below:
acupuncture – reduces chemotherapy-induced nausea and vomiting; improves quality of life
aromatherapy – improves sleep and quality of life
art therapy, music therapy – reduce anxiety and stress; manage fatigue; aid expression of feelings
counselling, support groups – help reduce distress, anxiety and depression; improve quality of life
hypnotherapy – reduces pain, anxiety, nausea and vomiting
massage – improves quality of life; reduces anxiety, depression, pain and nausea
meditation, relaxation, mindfulness – reduce stress and anxiety; improve coping and quality of life
qi gong – reduces anxiety and fatigue; improves quality of life
spiritual practices – help reduce stress; instil peace; improve ability to manage challenges
tai chi – reduces anxiety and stress; improves strength, flexibility and quality of life
yoga – reduces anxiety and stress; improves general wellbeing and quality of life.
Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based.
Alternative therapies are therapies used instead of conventional medical treatments. These are unlikely to be scientifically tested and may prevent successful treatment of the cancer. Cancer Council does not recommend the use of alternative therapies as a cancer treatment.
If you have been diagnosed with small bowel cancer, both the cancer and treatment will place extra demands on your body. Research suggests that eating well and exercising can benefit people during and after cancer treatment.
Eating well and being physically active can help you cope with some of the common side effects of cancer treatment, speed up recovery and improve quality of life by giving you more energy, keeping your muscles strong, helping you maintain a healthy weight and boosting your mood.
You can discuss individual nutrition and exercise plans with health professionals such as dietitians, exercise physiologists and physiotherapists.
All treatments can have side effects. The type of side effects that you may have will depend on the type of treatment and where in your body the cancer is. Some people have very few side effects and others have more. Your specialist team will discuss all possible side effects, both short and long-term (including those that have a late effect and may not start immediately), with you before your treatment begins.
One issue that is important to discuss before you undergo treatment is fertility, particularly if you want to have children in the future.
Common side effects may include:
Surgery – Bleeding, damage to nearby tissue and organs (including nerves), pain, infection after surgery, blood clots, weak muscles (atrophy), lymphoedema.
Radiation therapy – Fatigue, loss of appetite, nausea, bowel issues such as diarrhoea, abdominal cramps and excess wind, bladder issues, skin problems, lymphoedema, loss of fertility.
Chemotherapy – Fatigue, loss of appetite, nausea, bowel issues such as constipation or diarrhoea, hair loss, mouth sores, skin and nail problems, increased chance of infections, loss of fertility.
After treatment for small bowel cancer (especially surgery), you may need to adjust to changes in the digestion and absorption of food, or bowel function. These changes may be temporary or ongoing, and may require specialised help. If you experience problems, talk to your GP, specialist doctor, specialist nurse or dietitian.
This information is reviewed by
This information was last reviewed February 2021 by the following expert content reviewers: Prof David Goldstein, Medical Oncologist, Prince of Wales Hospital, Sydney, NSW; Craig Lynch, Colorectal Surgeon, Sydney Adventist Hospital, Sydney; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Wayne Reynolds, Consumer; Dr Stephen Thompson, Radiation Oncologist, Prince of Wales Hospital, Sydney, NSW.