Intestinal cancer treatments

Intestinal cancer is most often treated with surgery, sometimes in combination with chemotherapy or radiation. Your multidisciplinary team of cancer experts will answer your questions and recommend treatment options for your intestinal cancer based on your unique diagnosis and needs.

Members of a multidisciplinary team for intestinal cancer may include:

• A surgical oncologist to treat the cancer by performing surgery
• A radiation oncologist to treat the cancer using radiation
• A medical oncologist to treat the cancer using drugs such as chemotherapy
• A gastroenterologist to treat the cancer using expert knowledge of digestive diseases and issues

Beyond your core team of doctors, you will likely see many other health professionals, including nurses, dietitians, counselors and more for integrated and comprehensive care.

Before deciding on a treatment plan for intestinal cancer, your care team needs to determine whether surgery is a safe and beneficial option. Some intestinal tumors may be completely removed by surgery, although the type of surgery performed may vary depending on the tumor’s location. These tumors are called “resectable.”

Tumors that cannot be safely and completely removed by surgery are called “unresectable,” and must be treated through other methods. When a tumor is unresectable, this generally means that it’s more advanced and has invaded nearby or distant parts of the body, making it difficult to remove the cancer entirely.

The ability or inability to remove the cancer with surgery is one of the primary factors that influences intestinal cancer treatment decisions, but your doctors will also consider the overall status of your health and personal preferences. In some cases, poor overall health may preclude patients from undergoing surgery.

Other important factors include the cancer’s type, grade and stage, which all affect whether or not the tumor is resectable.

Common treatments for intestinal cancer include:

Surgery

Surgery is the most common treatment for intestinal cancer. At Cancer Treatment Centers of America^® (CTCA), experienced surgical oncologists perform surgery to remove tumors and the cancerous portion of the small intestine. In some cases, the following procedures may also be appropriate:

• Whipple procedure is most often performed as a treatment for pancreatic cancer. This complex surgical procedure is also used to treat cancer in the duodenum, the upper portion of the small intestine. The duodenum is where most small intestine cancers develop. In the Whipple procedure, the duodenum, part of the pancreas, gallbladder, a portion of the stomach, the end of the common bile duct and nearby lymph nodes are removed. Then, the remaining portions of the pancreas, small intestine and bile duct are connected. This allows bile from the liver to continue to drain into the small intestine, enabling digestion. This treatment for intestinal cancer does have potential risks for complications. Patients should seek treatment from surgical oncologists who are experienced in performing this procedure. Some of the potential risks and side effects of a Whipple procedure include:
  • Holes and leakage from the remaining portions of the various organs (if they’re not reconnected perfectly during the surgery)
  • Bleeding
  • Digestive issues, such as food getting stuck in the stomach
  • Weight loss
  • Infection
  • Bowel movement changes
• Palliative procedures may be used in advanced cases of small intestine cancer, when surgery to remove the cancer may not be an option because the disease is too widespread. To relieve symptoms such as pain and nausea caused when a tumor is blocking the small intestine, palliative surgery may be performed to help patients feel more comfortable. For example, if a tumor blocks a passage in the small intestine, surgery may be performed to insert a small tube that bypasses the tumor, creating an opening from the stomach to the other end of the small intestine or to the large intestine. This enables you to continue to eat normally and digest food. This is called a stent placement. Another palliative surgery that may be an option is called bypass surgery. In this operation, your surgeon reroutes the passage of digested food to bypass the tumor.
• Hemicolectomy, or segmental resection, is a procedure that involves taking out the part of the intestine where the tumor resides. Some healthy intestinal tissues surrounding the tumor are also removed. Then, the surgeon reconnects the remaining ends of the intestine. Nearby lymph nodes are also removed. If the tumor is located in the lower part of the small intestine, some of the large intestine (colon) may need to be excised. A hemicolectomy is usually an “open” surgery, meaning that the surgeon will start by cutting an opening in the abdomen. Sometimes, if the cancer is smaller, your surgeon may be able to do laparoscopic surgery. In this case, small holes are made in different locations around your abdomen, and the surgeon inserts tools into these holes to perform the surgery. Since only a minor portion of the intestine is removed during this surgery, there is a relatively low risk of long-term digestive problems compared with other types of intestinal surgeries. However, all surgeries come with risks, including bleeding and infections. If your colon is removed, the potential for digestive complications is higher. In the days following the surgery, you may be unable to drink and consume food normally. A hemicolectomy is generally used for intestinal cancers located in the middle or end of the small intestine. Tumors in the top of the small intestine are typically removed through a Whipple procedure.

Chemotherapy

Chemotherapy for small intestine cancer may be given to treat cancer that has spread, or metastasized, to other areas of the body or to help kill cancer cells that may remain in the abdomen after surgery.

Chemotherapy is rarely used to treat adenocarcinomas in the small intestine because it has not been found to be a beneficial treatment in most cases. However, it’s sometimes an option for intestinal cancers that have metastasized (spread widely in the body) or as a follow-up treatment to surgery to reduce the risk that any cancer is left behind. Intraperitoneal chemotherapy may be an option for cancers that have spread to the peritoneum (inner lining of the abdomen). This procedure involves injecting chemotherapy drugs into your abdominal cavity after surgery is finished.

When chemotherapy is used, the following drugs are common choices:

• Capecitabine
• 5-fluorouracil (5-FU)
• Oxaliplatin
• Irinotecan

Potential side effects of chemotherapy may include nausea, vomiting, hair loss and mouth sores. Your care team may recommend multiple measures to help reduce or manage chemotherapy-related symptoms.

Prior to receiving chemotherapy for intestinal cancer, you may receive pre-medications to help make side effects more tolerable. During chemotherapy, your care team will offer supportive care services designed to ease side effects and support your quality of life.

Radiation therapy

Radiation therapy may be a treatment option for intestinal cancer. With today’s radiation therapy delivery systems, our radiation oncologists are better able to target difficult-to-reach tumors in the small intestine. Our radiation oncologists may also direct higher radiation doses at intestinal cancer cells, while reducing exposure to normal, healthy tissue.

Radiation therapy may be part of the treatment plan for unresectable intestinal cancer. In some cases, patients with this type of cancer may undergo surgery to repair blockage. Radiation may be used as a follow-up treatment to surgery, as well as to relieve symptoms caused by a large tumor (because it reduces the size).

When radiation is used to treat intestinal cancer, it is most often external beam radiation therapy (EBRT).

Sophisticated forms of intensity modulated radiation therapy (IMRT) may be used to treat cancer of the small intestine.

Some of the potential side effects of radiation therapy for intestinal cancer include:

• Excessive tiredness
• Stomach upset (nausea, vomiting, diarrhea)
• Skin irritation at the treatment site, including redness, blistering and peeling

Immunotherapy

Immunotherapy, which uses drugs or substances to help your immune system find and attack cancer cells, may be an option for some people with unresectable intestinal cancer that has metastasized. It’s typically used for people whose cancer cells contain specific genetic mutations (changes within their DNA) that make their cancer potentially susceptible to certain immunotherapy drugs. Metastatic intestinal cancers with these targetable gene changes may benefit from treatment with a type of immunotherapy called checkpoint inhibitors. Keytruda (pembrolizumab) is one example of a checkpoint inhibitor that may be used in these instances.

Metastatic intestinal cancer

When intestinal cancer spreads from its original location to nearby tissues or distant parts of the body, it is considered metastatic and is typically unresectable. The treatment plan will likely include some combination of chemotherapy, radiation therapy, immunotherapy and palliative surgery (to relieve symptoms and reverse intestinal blockages).

Some patients with metastatic intestinal cancer may want to consider enrolling in a clinical trial to access new and experimental treatment options.

Recurrent intestinal cancer

After treatment, intestinal cancer may return. This is called recurrent cancer. Intestinal cancer may recur at or near its original location (the intestines) or in a distant part of the body.

If cancer recurs in the small intestine, it may be treated with surgery, radiation therapy or chemotherapy—either alone or in combination. In some cases, treatment may be focused on relieving symptoms (palliative therapy). Enrolling in a clinical trial may also be an option.

Intestinal cancer that recurs in a distant part of the body will generally be treated in a clinical trial, as there is a lack of standard options for cancer at this stage. Clinical trials for this stage of cancer typically involve new immunotherapy drugs.

Clinical trials

Enrolling in a clinical trial is a way to access novel treatments for intestinal cancer. Clinical trials investigate the benefits of innovative cancer treatments and compare them with the standard options.

Clinical trials may be particularly beneficial for patients with advanced intestinal cancer that cannot be completely removed by surgery. There is a lack of standardized treatment options for cancers at this stage, and enrolling in a clinical trial may provide alternatives to those who need them.

The National Cancer Institute lists clinical trials testing immunotherapy and other approaches as a primary treatment option for metastatic or recurrent intestinal cancer.

Cancer Treatment Centers of America^® (CTCA) may have clinical trials available for some patients with intestinal cancer. Speak with your doctor to learn more about clinical trials and whether they may benefit you.

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