Materiały źródłowe

• #1 Small Intestine Cancer Treatment – NCI

  https://www.cancer.gov/types/small-intestine/patient/small-intestine-treatment-pdq

  Small intestine cancer is a rare disease in which malignant (cancer) cells form in the tissues of the small intestine. […] There are different types of treatment for patients with small intestine cancer. […] The following types of treatment are used: Surgery, Radiation therapy, Chemotherapy. […] Surgery is the most common treatment of small intestine cancer. […] After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. […] Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

• #2 Small Intestine Cancer: Symptoms, Causes, Prognosis & Treatment

  https://my.clevelandclinic.org/health/diseases/6225-small-intestine-cancer

  Most small intestine cancer forms in either your duodenum or ileum. […] The treatment you receive depends on the type of cancer you have, its stage, where the tumor is located and even the characteristics of the cells inside the tumor. Your preferences will also guide treatment decisions. […] Surgery is the most common treatment for small intestine cancer. Surgery may include: Resection: Surgery to remove all or part of an organ that contains cancer. Your healthcare provider may remove segments of your small intestine and nearby organs (if the cancer has spread). Afterward, they may perform an anastomosis (joining the cut ends of the intestine together). Your healthcare provider may remove lymph nodes near your small intestine to test them for signs of cancer spread. […] Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.

• #3 Intestinal Cancer Treatment Options: Surgery, Radiation & More

  https://www.cancercenter.com/cancer-types/intestinal-cancer/treatments

  Intestinal cancer is most often treated with surgery, sometimes in combination with chemotherapy or radiation. […] Common treatments for intestinal cancer include: […] Surgery is the most common type of treatment for intestinal cancer. […] 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. […] Radiation therapy may be a treatment option for intestinal cancer. […] Immunotherapy, which uses drugs or substances to help the immune system find and attack cancer cells, may be an option for some people with unresectable intestinal cancer that has metastasized. […] The treatment plan will likely include some combination of chemotherapy, radiation therapy, immunotherapy and palliative surgery (to relieve symptoms and reverse intestinal blockages). […] If cancer recurs in the small intestine, it may be treated with surgery, radiation therapy or chemotherapy—either alone or in combination. […] Enrolling in a clinical trial is a way to access novel treatments for intestinal cancer.

• #4 Treatment | Small bowel cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/small-bowel-cancer/treatment

  Treatment options include: surgery to relieve a blocked bowel, unblocking the bowel with a tube called a stent, chemotherapy, radiotherapy. […] 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: cancer, surrounding tissues, lymph nodes. […] Sometimes cancer can grow so that it completely blocks the bowel. This is called a bowel obstruction. […] To relieve symptoms, it is sometimes possible to: unblock the bowel by putting in a tube called a stent, remove the blocked section of bowel. […] Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

• #4 Treatment | Small bowel cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/small-bowel-cancer/treatment

  You might have chemotherapy to reduce or control symptoms of advanced cancer. […] Radiotherapy uses high energy rays to destroy cancer cells. […] Radiotherapy isn’t used much for small bowel cancer. It is mainly used to treat more advanced small bowel cancers. Advanced cancer means that the cancer has spread to another part of the body. […] Radiotherapy can help to control symptoms you have because of advanced cancer, such as pain. […] Researchers are interested in: whether chemotherapy after surgery can improve survival, comparing different cancer drugs, looking at the drug bevacizumab in combination with chemotherapy.

• #5

  https://www.cancervic.org.au/cancer-information/types-of-cancer/small_bowel_cancer/small_bowel_overview.html

  You will be cared for by a multi-disciplinary team (MDT) of health professionals during your treatment, which may include a surgeon, radiation oncologist, gastroenterologist and dietitian, among others. […] 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. […] A resection is the 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.

• #6 Small bowel cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/bowel-cancer/small-bowel-cancer

  Treatment for small bowel cancer involves a team of specialists who discuss the best possible treatment for the patient. This team is called a multidisciplinary team (MDT). The MDT will look at national guidelines to help plan the treatment. […] Your treatment plan may depend on your general health, the position and size of the cancer, whether it has spread to other areas of the body, and your personal choices. […] Surgery is the most common treatment for small bowel cancer. You might have surgery on its own or with other treatments. […] Surgery involves removing all or part of the cancer with an operation. It is the main treatment for small bowel cancer that has not spread or is not causing problems. […] Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy the cancer cells. For small bowel cancer, it may be used before or after surgery to shrink the cancer and reduce the risk of it coming back.

• #6 Small bowel cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/bowel-cancer/small-bowel-cancer

  The chemotherapy drugs most commonly used to treat small bowel cancer are fluorouracil (5FU), capecitabine (Xeloda), oxaliplatin (Eloxatin), and irinotecan (Campto). […] Targeted therapy drugs find and attack cancer cells. For small bowel cancer, some people have a drug called bevacizumab along with their chemotherapy. […] Immunotherapy is not commonly used for small bowel cancer, but it might be suitable for some people. […] Palliative radiotherapy uses high-energy rays to destroy cancer cells. It may be used to shrink the cancer and to help relieve symptoms such as pain or bleeding.

• #7 Duodenal/Small Bowel Cancer | AdventHealth Digestive Health Institute West Florida

  https://digestivehealth.adventhealth.com/institute/west-florida/surgical-cancer-care/duodenal-small-bowel-cancer

  Our surgeons at the AdventHealth Digestive Institute Tampa offer minimally invasive surgery to treat a number of digestive cancers, including small bowel and duodenal cancer. […] Surgery is often the first line of treatment for small bowel cancers, and it is the only treatment to date that can cure a small bowel cancer. […] At Digestive Institute Tampa, surgery for small bowel cancers can often be done as a minimally invasive procedure that takes one of three forms: […] Cancers of the duodenum are treated with a pancreaticoduodenectomy, more commonly known as a Whipple procedure. […] Small bowel cancers in the lower part of the small intestine can often be treated with segmental resection. […] For small bowel cancers that cannot be surgically removed because they are at an advanced stage, Digestive Institute offers procedures that can help relieve a patients pain or symptoms.

• #8 Treatment of small bowel neoplasms – UpToDate

  https://www.uptodate.com/contents/treatment-of-small-bowel-neoplasms

  Treatment of small bowel neoplasms […] The treatment of the various types of neoplasms that arise in the small bowel will be reviewed here. […] Surgery — Localized invasive adenocarcinomas of the small bowel are best managed with wide segmental surgical resection. Resection of the primary and investing mesentery achieves surgical clearance of both the primary and the regional nodes at risk for metastases, and provides important staging information that impacts decisions regarding the need for adjuvant therapy (see below). […] Pancreaticoduodenectomy is required for tumors involving the second portion of the duodenum and for those invading into any portion of the ampulla or pancreas. […] The optimal number of regional lymph nodes needed for adequate staging is debated, but guidelines from the National Comprehensive Cancer Network (NCCN) recommend that a goal for all small bowel adenocarcinoma resections should be the retrieval of at least eight regional nodes. […] Retrospective reviews suggesting benefit for palliative chemotherapy in small bowel adenocarcinoma.

• #9 Malignant Neoplasms of the Small Intestine Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/282684-guidelines

  Patients with SBA require a complete staging workup, including the following: […] Primary treatment for local (stage IIII) SBA consists of surgical resection with en bloc removal of at least 8 regional lymph nodes. […] The type of resection used to treat localized SBA depends on the location of the primary tumor, as follows: Segmental resection of the small bowel is often the mainstay of treatment. […] Participation in a clinical trial is preferred for all patients with SBA who are considering adjuvant therapy, as the optimal approach is unknown. […] Observation is recommended after surgical treatment of all stage I SBA tumors and stage II tumors that have high MSI (MSI-H) or deficient MMR (dMMR). […] Six months of adjuvant treatment with FOLFOX, CAPEOX, 5-FU/LV, or capecitabine is recommended for any locally advanced SBA with positive lymph nodes (stage III).

• #9 Malignant Neoplasms of the Small Intestine Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/282684-guidelines

  Chemoradiation with capecitabine or infusional 5-FU is another option for stage III duodenal cancer that is margin-positive after resection. […] Patients with locally unresectable or medically inoperable SBA may undergo neoadjuvant therapy, with routine monitoring for conversion to resectable disease. […] Recommended first-line chemotherapy regimens are FOLFOX, CAPEOX, FOLFOXIRI (infusional 5-FU, LV, oxaliplatin, irinotecan), or FOLFIRINOX (same drugs as FOLFOXIRI, but with bolus 5-FU and higher irinotecan dose) any of which may be combined with bevacizumab. […] For intensive subsequent lines of therapy, recommended regimens include the following, if not previously given: FOLFOX bevacizumab, CAPEOX bevacizumab, FOLFIRI bevacizumab, Irinotecan, Taxane-based chemotherapy. […] Treatments based on tumor molecular testing results are as follows: BRAF V600E mutation Dabrafenib + trametinib, TMB-high (10 mut/Mb) Pembrolizumab, NTRK gene fusion Entrectinib, Larotrectinib, or repotrectinib, RET gene fusion Selpercatinib, HER2-amplified (immunohistochemistry 3+) Fam-trastuzumab deruxtecan-nxki, KRAS G12C mutation positive Sotorasib or adagrasib. […] For resectable peritoneal carcinomatosis, surgical cytoreduction may be considered. […] Due to the lack of data regarding optimal surveillance following curative-intent treatment of SBA, an approach similar to that for colorectal cancer is recommended.

• #10 Treatments for unresectable small intestine cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/small-intestine/treatment/unresectable

  You may be offered surgery to relieve pain and other symptoms caused by small intestine adenocarcinoma, such as nausea and vomiting. This is called palliative surgery. […] You may be offered radiation therapy for unresectable small intestine adenocarcinoma. It is most often used to relieve pain or control the symptoms of advanced cancer (called palliative care). […] Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. You may have neurotrophic tyrosine receptor kinase (NTRK) therapy to treat unresectable small intestine adenocarcinoma. […] Immunotherapy drugs may be offered for unresectable small intestine adenocarcinoma if the tumour has certain genetic changes defined as high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR). These drugs will only be tried if the cancer has spread and doesn’t respond to other treatments. […] Clinical trials look at new and better ways to prevent, find and treat cancer. Small intestine adenocarcinoma is rare, so very few clinical trials in Canada are open to people with this type of cancer.

• #11 Treatment Choices for Small Intestine Cancer (Adenocarcinoma), Based on Tumor Spread | American Cancer Society

  https://www.cancer.org/cancer/types/small-intestine-cancer/treating/by-tumor-spread.html

  The treatment of small intestine cancer depends mainly on whether or not the cancer can be removed completely with surgery. Cancers that can be removed completely are called resectable, while those that cannot are called unresectable. […] Resectable cancers are treated with surgery to remove the cancer and some healthy surrounding tissue. […] If the cancer has grown through the wall of the intestine or spread to nearby lymph nodes, the doctor may recommend adjuvant chemotherapy (chemo) or radiation therapy after surgery to try to kill any cancer cells that may have been left behind but were too small to see. […] Some doctors are also testing if giving chemo or radiation before surgery (known as neoadjuvant therapy) might be helpful. […] A small intestine cancer may be unresectable if it has grown into nearby tissues or if it has spread to other organs and tissues (or if a person isn’t healthy enough for major surgery).

• #12 Small Intestine Cancer Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/small-intestine/hp/small-intestine-treatment-pdq

  As in other gastrointestinal malignancies, the predominant modality of treatment is surgery when resection is possible, and cure relates to the ability to completely resect the cancer. […] […] For resectable primary disease: Radical surgical resection. […] […] For unresectable primary disease: Surgical bypass of obstructing lesion. Palliative radiation therapy. Clinical trials evaluating methods to improve local control, such as the use of radiation therapy with radiosensitizers with or without systemic chemotherapy. […] […] For unresectable metastatic disease: Clinical trials evaluating the value of new anticancer drugs and biological therapy (phase I and phase II studies). […] […] For metastatic adenocarcinoma or leiomyosarcoma: No standard effective chemotherapy exists for patients with recurrent metastatic adenocarcinoma or leiomyosarcoma of the small intestine. These patients should consider enrolling in phase I or II clinical trials evaluating new anticancer drugs or biological therapy. […] […] For locally recurrent disease: Surgery. Palliative radiation therapy. Palliative chemotherapy. Clinical trials evaluating ways of improving local control, such as the use of radiation therapy with radiosensitizers with or without systemic chemotherapy.

• #13 Management of Advanced Small Bowel Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7489287/

  Finally, the high incidence of MSI, ranging from 5 to 45% in different studies, and the higher tumor mutational burden of SBA, alongside data showing high PD-1 and PDL-1 expression in this tumor type, support a potential benefit from immunotherapy. […] Pembrolizumab, an anti-PD1 monoclonal antibody, has already been approved by the U.S. Food and Drug Administration (FDA) in May 2017 for the treatment of a variety of advanced MSI-high or dMMR solid tumors including SBA. […] Although encouraging, these results require further validation. […] The combined treatment strategy of cytoreduction plus HIPEC achieved prolonged survival for selected patients with acceptable morbidity and mortality. […] Overall, the 5-year survival for SBA patients is poor (14 to 33%), decreasing from 50 to 60% for stage I tumors to 35% for stage IV.

• #13 Management of Advanced Small Bowel Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7489287/

  However, retrospective series comparing different regimens consistently reported best results in terms of response, survival, and toxicity with the use of 5-fluorouracil/leucovorin plus oxaliplatin (FOLFOX). […] More recently, several prospective phase II studies confirmed this retrospective evidence, showing response rates of 4550%, disease control rates of 8090%, and a median OS of 1520 months following frontline treatment with either FOLFOX or capecitabine plus oxaliplatin (CAPOX). […] To date, contrary to CRC, few data are available exploring the benefit of specific biologic or targeted therapies in the treatment of advanced SBA. […] Notably, the rates of KRAS and BRAF mutations in SBA were similar to CRC, although BRAF V600E mutations were less common in SBA and case reports have described responses to anti-EGFR therapy in patients with KRAS wild-type tumors.

• #13 Management of Advanced Small Bowel Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7489287/

  Small bowel cancer is a rare disease, despite its incidence is increasing in the last decade. […] Immunotherapy for small bowel adenocarcinomas, several multikinase inhibitors in resistant GIST patients, as well as everolimus and 177Lu-DOTATATE in neuroendocrine tumors are only few of the novel therapeutic options that have changed, or may change in the future, the therapeutic landscape of these rare cancers. […] Larger and more powerful studies on the molecular profile of these tumors may lead to a better design of clinical trials, which eventually would provide our patients with more efficacious treatments to improve both overall survival and quality of life. […] The management of advanced SBA (i.e., unresectable or metastatic) is based on systemic treatment, although no randomized studies have been performed to demonstrate a benefit of systemic chemotherapy in patients with advanced disease.

• #14 Small Intestine Cancer – Gastrointestinal Cancer | UCLA Health Jonsson Comprehensive Cancer Center

  https://www.uclahealth.org/cancer/cancer-services/gi-cancer/conditions/small-intestine-cancer

  After surgery, your doctor may recommend radiation therapy, which uses powerful X-rays to destroy cancer cells. Advanced forms of radiation therapy shape radiation beams to the tumor to reduce damage to delicate intestinal tissues. […] Your surgeon may recommend HIPEC if cancer cells have metastasized to the abdominal cavity. This specialized treatment bathes the abdominal cavity in a chemotherapy solution immediately after surgery to destroy as many cancer cells as possible. […] Through clinical trials, UCLA doctors offer several new small bowel cancer therapies that arent widely available. Researchers are studying biologic treatments, or immunotherapies, that use the bodys immune system to fight small intestine cancer. […] Targeted therapy blocks gene changes in gastrointestinal stromal tumors to prevent cancer from growing. These drugs are often the first treatment for GISTs, and they may work for GISTs when chemotherapy does not. You may have targeted therapy before or after surgery, or to improve your quality of life when surgery cant remove a tumor completely.

• #15 Chemotherapy for Small Intestine Cancer | NYU Langone Health

  https://nyulangone.org/conditions/small-intestine-cancer/treatments/chemotherapy-for-small-intestine-cancer

  Chemotherapy for small intestine cancer may be given through a vein with intravenous (IV) infusion or may be taken by mouth. The duration of treatment varies from person to person, depending on how advanced the cancer is. […] NYU Langone doctors may use chemotherapy, drugs that destroy cancer cells throughout the body, to manage small intestine cancer. […] Doctors may recommend chemotherapy when small intestine cancer has spread to other organs and cannot be managed with surgery, because it is too advanced. […] Chemotherapy may be given after surgery for small intestine cancer. This approach is called adjuvant chemotherapy and may help reduce the risk of the cancer returning. […] Typically, people have IV infusions over a period of two days every two weeks, allowing the body to recover in between. This cycle may be repeated for several months. Other chemotherapy medications may be taken by mouth daily for several weeks, followed by treatment breaks.

• #15 Chemotherapy for Small Intestine Cancer | NYU Langone Health

  https://nyulangone.org/conditions/small-intestine-cancer/treatments/chemotherapy-for-small-intestine-cancer

  Some of the most common chemotherapy drugs doctors prescribe for small intestine cancer include fluorouracil, capecitabine, irinotecan, and oxaliplatin. […] NYU Langone doctors, nurses, nutritionists, and other specialists can help you minimize and manage common side effects of chemotherapy, which may include nausea, vomiting, diarrhea, skin rashes, and mouth sores. […] Steps may be taken before or during treatment to help reduce or minimize side effects. For example, specialists can provide lotions, mouthwashes, and other aids to help manage skin rashes and mouth sores. […] Doctors can also adjust the dose of your medication, substitute other drugs, prescribe antinausea and pain medications, and recommend supportive services.

• #16 Treatments for small intestine cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/small-intestine/treatment

  Your healthcare team will create a treatment plan just for you. The plan is based on your health and specific information about the cancer. What you want is also important when planning treatment. When deciding which treatments to offer for small intestine cancer, your healthcare team will consider: […] Surgery and chemotherapy are the main treatments for small intestine adenocarcinoma. Radiation therapy, targeted therapy and immunotherapy are also treatment options for some people. […] Surgery is the main treatment for small intestine adenocarcinoma that can be completely removed. Chemotherapy may also be used. […] Chemotherapy is the primary treatment for unresectable small intestine adenocarcinoma. Surgery and radiation may also be offered. In certain cases, targeted therapy or immunotherapy may be offered.

• #16 Treatments for small intestine cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/small-intestine/treatment

  There is no standard treatment for recurrent small intestine adenocarcinoma. Chemotherapy, targeted therapy, immunotherapy, radiation therapy or surgery may be used. […] Surgery is often offered for small intestine adenocarcinoma. The type of surgery depends mainly on where the tumour is in the small intestine and if it can be completely removed. […] Chemotherapy uses anticancer drugs to destroy cancer cells. Small intestine adenocarcinoma is sometimes treated with chemotherapy. […] Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is sometimes used to treat small intestine adenocarcinoma. […] Targeted therapy uses drugs to target specific molecules on cancer cells. Metastatic small intestine adenocarcinoma is sometimes treated with targeted therapy. […] Small intestine adenocarcinoma is sometimes treated with immunotherapy. It helps strengthen the immune system to fight cancer. […] Follow-up is an important part of care for small intestine adenocarcinoma. It often involves regular tests and visits with the healthcare team.

• #17 Small Bowel Adenocarcinoma, Version 1.2020, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 17 Issue 9 (2019)

  https://jnccn.org/view/journals/jnccn/17/9/article-p1109.xml

  For local (stage IIII) SBA, primary treatment consists of surgical resection with en bloc removal of the regional lymph nodes. […] Localized SBAs are treated with surgical resection, but local and distant recurrences are common, and optimal perioperative therapy is unknown. […] Therefore, participation in a clinical trial is preferred for all patients with SBA who are considering adjuvant therapy. […] The ongoing, international phase III BALLAD trial is the first prospective trial investigating the role of adjuvant 5-FU/leucovorin (5-FU/LV) or 5-FU/LV plus oxaliplatin (FOLFOX) compared with observation alone for patients with stage IIII SBA. […] For some patients with locally unresectable or medically inoperable SBA, conversion to resectable disease may be a goal. […] Based on these data, the panel recommends that patients with locally unresectable or medically inoperable SBA may undergo neoadjuvant therapy, during which they should be routinely monitored for conversion to resectable disease.

• #17 Small Bowel Adenocarcinoma, Version 1.2020, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 17 Issue 9 (2019)

  https://jnccn.org/view/journals/jnccn/17/9/article-p1109.xml

  Based on these data, FOLFOX or CAPEOX are recommended as first-line therapy options for treatment of patients with advanced SBA who are appropriate for intensive therapy. […] Based on the results of this study, the FDA granted accelerated approval to pembrolizumab in May 2017 for patients with unresectable or metastatic dMMR or MSI-H solid tumors that have progressed after prior treatment and have no satisfactory alternative treatment options. […] Based on these positive results for CRC and the data showing benefit of pembrolizumab in SBA, the NCCN panel recommends either pembrolizumab or nivolumab, with or without ipilimumab, as second-line treatment options for dMMR/MSI-H advanced SBA.

• #17 Small Bowel Adenocarcinoma, Version 1.2020, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 17 Issue 9 (2019)

  https://jnccn.org/view/journals/jnccn/17/9/article-p1109.xml

  Approximately 32% of patients diagnosed with SBA have stage IV (distant metastatic) disease. […] The NCCN recommendations for treatment of stage IV SBA are discussed subsequently. […] Although resectable metastases are rare for SBA and the data supporting metastasectomy for SBA are limited, a retrospective analysis of patients with non-CRC, nonendocrine liver metastases (including 28 patients with small bowel cancers and 12 patients with duodenal cancers) showed promising survival rates after resection of liver metastases. […] Data supporting systemic therapy for advanced adenocarcinoma of the small bowel were also almost entirely limited to retrospective reports, although recently several small phase II trials for SBA have been reported. […] The choice of therapy is based on consideration of the goals of therapy, the type and timing of prior therapy, and the differing toxicity profiles of the constituent drugs.

• #17 Small Bowel Adenocarcinoma, Version 1.2020, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 17 Issue 9 (2019)

  https://jnccn.org/view/journals/jnccn/17/9/article-p1109.xml

  Small bowel adenocarcinoma (SBA) is a rare malignancy of the gastrointestinal tract that has increased in incidence across recent years. […] The NCCN Guidelines for Small Bowel Adenocarcinoma were created to establish an evidence-based standard of care for patients with SBA. These guidelines provide recommendations on the workup of suspected SBA, primary treatment options, adjuvant treatment, surveillance, and systemic therapy for metastatic disease. […] The treatment recommendations in this guideline only refer to SBA. For gastrointestinal stromal tumors, see the NCCN Guidelines for Soft Tissue Sarcoma; for neuroendocrine tumors, see the NCCN Guidelines for Neuroendocrine and Adrenal Tumors; and for small bowel lymphomas see the NCCN Guidelines for B-Cell Lymphomas (all available at NCCN.org).

• #18 Malignant Neoplasms of the Small Intestine Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/282684-treatment

  The mainstay of treatment for adenocarcinoma and leiomyosarcoma is radical surgical resection. If the lesion is unresectable, surgical bypass of obstruction and palliative radiation therapy are treatment options. […] For chemotherapy of small-bowel adenocarcinomas, National Comprehensive Cancer Network (NCCN) guidelines recommend fluoropyridimine/platinum combinations such as FOLFOX (fluorouracil, leucovorin, oxaliplatin) or CAPEOX (capecitabine, oxaliplatin), with or without bevacizumab. […] However, no standard effective chemotherapy exists for patients with recurrent metastatic adenocarcinoma or leiomyosarcoma of the small intestine. These patients should be considered candidates for clinical trials evaluating the use of new anticancer drugs or biologic agents. […] Although surgical resection remains the primary component of treatment, distant recurrence is frequent after surgical resection, and this suggests a role for adjuvant systemic therapy. Chemotherapy is associated with improved longterm survival and increasing retrospective evidence supports the use of adjuvant chemotherapy, particularly in patients with regional lymph node involvement.

• #19 Small bowel cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/small-bowel-cancer/diagnosis-treatment/drc-20442293

  Radiation therapy. Radiation therapy uses powerful energy beams to kill cancer cells. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body. Radiation therapy is sometimes combined with chemotherapy before surgery to shrink the size of the cancer. […] Targeted therapy. Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Targeted therapy might be used for small bowel cancer when surgery isn’t an option or when the cancer spreads to other parts of the body. […] Immunotherapy. Immunotherapy is a treatment with medicine that helps your body’s immune system to kill cancer cells. Your immune system fights off diseases by attacking germs and other cells that shouldn’t be in your body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. Immunotherapy might be an option for advanced small bowel cancer if testing shows the cancer cells may respond to this type of treatment.

• #20 Radiation Therapy for Small Intestine Cancer | NYU Langone Health

  https://nyulangone.org/conditions/small-intestine-cancer/treatments/radiation-therapy-for-small-intestine-cancer

  NYU Langone doctors may recommend radiation therapy to manage some small intestine tumors. This therapy uses high-energy beams to destroy cancer cells. […] Doctors may use radiation therapy after surgery to remove tumors in the duodenum and nearby cancerous lymph nodes. Radiation therapy helps destroy any remaining cancer cells. […] Radiation therapy may also be used to shrink small intestine tumors in people who cannot have surgery because the cancer is too advanced. This helps relieve pain and pressure on surrounding tissues. […] Radiation oncologists use special CT scans of the small intestine tumor area and nearby tissue and organs in conjunction with computer-based treatment planning software. The result is a three-dimensional image of the treatment area and surrounding organs. This information helps your doctors determine how best to target the cancer and spare healthy tissue.

• #20 Radiation Therapy for Small Intestine Cancer | NYU Langone Health

  https://nyulangone.org/conditions/small-intestine-cancer/treatments/radiation-therapy-for-small-intestine-cancer

  Doctors may use CT scans during treatment sessions to ensure the radiation therapy precisely targets the small intestine tumor while avoiding other important organs. This approach, called image-guided radiation therapy, helps compensate for the natural moving and shifting of organs during treatment. […] NYU Langone doctors typically use external beam radiation therapy, which is delivered by a machine called a linear accelerator. The machine rotates around your body during therapy to focus radiation beams to the tumor. Sessions are usually once daily, five days a week, for several weeks. Total treatment time may vary. […] Three-dimensional conformal radiation therapy allows doctors to deliver radiation beams tailored to the size, shape, and location of the tumor, sparing healthy tissue and reducing the risk of side effects. Using the linear accelerator, the oncologist aims radiation beams at the tumor from different directions.

• #20 Radiation Therapy for Small Intestine Cancer | NYU Langone Health

  https://nyulangone.org/conditions/small-intestine-cancer/treatments/radiation-therapy-for-small-intestine-cancer

  Intensity modulated radiation therapy is more targeted than the three-dimensional conformal approach. It allows doctors to divide treatment into many small, computer-controlled beams of different strengths. Together, these beams closely conform to the size, shape, and location of the small intestine tumor. […] Doctors can adjust the radiation dose within millimeters to spare surrounding healthy tissue. This approach may enable doctors to use higher doses of radiation therapy. […] NYU Langone doctors carefully target radiation therapy to avoid side effects. However, people may sometimes experience temporary skin irritation, fatigue, nausea, gassiness, cramping, and decreased appetite. Rarely, radiation therapy may cause an ulcer, which is an open sore, in the intestine. […] Doctors can prescribe topical medications to manage skin irritation and medications to alleviate nausea and gassiness. They may also recommend nutritional changes and physical activity to manage fatigue. Medications and surgery may be needed to manage ulcers.

• #21 Small Bowel Cancer | Cancer Council

  https://www.cancer.org.au/cancer-information/types-of-cancer/rare-cancers/small-bowel-cancer

  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. […] Immunotherapy or biological therapy uses the bodys 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 cant 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.

• #21 Small Bowel Cancer | Cancer Council

  https://www.cancer.org.au/cancer-information/types-of-cancer/rare-cancers/small-bowel-cancer

  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; your age, fitness and general health and 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. […] Chemotherapy 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.

• #21 Small Bowel Cancer | Cancer Council

  https://www.cancer.org.au/cancer-information/types-of-cancer/rare-cancers/small-bowel-cancer

  In some cases of small bowel cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer. […] As well as slowing the spread of small bowel cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.

• #22 Small Intestine Cancer | Causes, Symptoms, & Treatment | MedStar Health

  https://www.medstarhealth.org/services/small-intestine-cancer

  Many times, patients benefit from other treatments in addition to surgery. […] Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells. […] Your care team will include a medical oncologist who will determine if you may benefit from chemotherapy with or without other therapies. […] Through clinical trials, we’re learning new ways to treat adenocarcinomas and leiomyosarcomas using drugs that use your immune system to slow cancer growth. […] Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells. […] If the tumor in your small intestine cannot be removed, your radiation oncologist may recommend external radiation therapy to shrink the tumor (with or without chemotherapy) or relieve symptoms and improve your quality of life.

• #23 Treating bowel cancer | The Royal Marsden

  https://www.royalmarsden.nhs.uk/private-care/news-and-blogs/treating-bowel-cancer

  During chemotherapy, we use anti-cancer medications to kill cancer cells. […] Different medication options include fluorouracil (5FU), irinotecan, oxaliplatin, and raltitrexed. […] As with most treatments, you can expect some side effects. Common side effects of chemotherapy are feeling or being sick, diarrhoea, a sore mouth and thinning hair or hair loss. […] Radiation therapy, or radiotherapy, involves using radiation to destroy cancer cells. […] We often combine radiotherapy with chemotherapy (chemoradiotherapy) instead of using radiotherapy alone. […] We use targeted or biological therapy to address the cell changes that cause colon or rectal cancer and prevent cell growth. […] Researchers continue to look for new ways to treat bowel cancer so we can provide personalised treatment for everyone. Recently, there have been great strides in immunotherapy treatments for advanced bowel cancer.

• #23 Treating bowel cancer | The Royal Marsden

  https://www.royalmarsden.nhs.uk/private-care/news-and-blogs/treating-bowel-cancer

  In 2021, NICE approved a combination of two immunotherapy drugs, nivolumab and ipilimumab, for advanced bowel cancer. […] NICE also approved pembrolizumab in 2021, another immunotherapy drug for those at an advanced stage with MMR gene mutations. […] Our highly trained specialists will explain each option available to you in detail, discussing their pros and cons while providing a tailored recommendation based on your needs and preferences.

• #24 Bowel cancer

  https://www.cancervic.org.au/cancer-information/types-of-cancer/bowel_cancer/treatment_for_early_bowel_cancer.html

  Radiation therapy may be recommended for rectal cancer but is rarely used to treat colon cancer. […] Radiation therapy is used before surgery to shrink the tumour. This makes it easier for the surgeon to remove the cancer and reduces the risk of the cancer coming back. […] Chemotherapy uses drugs to kill or slow the growth of cancer cells while doing the least possible damage to healthy cells. […] Some people with rectal cancer have chemotherapy before surgery to shrink it so it’s easier to remove. […] Chemotherapy after surgery for colon or rectal cancer aims to destroy any remaining cancer cells and reduce the chance of the cancer coming back.

• #25 Small bowel cancer treatment at GenesisCare

  https://www.genesiscare.com/uk/condition/cancer/gastrointestinal-cancer/small-bowel-cancer

  Chemotherapy uses anti-cancer drugs to destroy cancer cells. Chemotherapy is not often a primary treatment for small bowel cancer, but it may be delivered after surgery to reduce the chance of cancer from returning, or to treat advanced small bowel cancers cancer that have spread (metastasised) to other parts of the body. […] Targeted (also called biological) therapies are a specialised group of drugs that have been designed to attack or block specific processes in cancer cells that tumours depend on to survive and grow. […] Radiotherapy uses targeted, high-energy radiation beams to destroy cancer cells. Radiotherapy is not a common small bowel cancer treatment, but it may be used to shrink the tumour before surgery or reduce the cancer risk coming back after surgery. […] At GenesisCare, we offer VMAT wherever possible because it is widely recognised to be the highest standard of care currently available for patients needing this type of radiotherapy. […] If your cancer has spread to other parts of the body, its called advanced or metastatic small bowel cancer. At GenesisCare, you can receive palliative drug treatment for advanced small bowel cancer, to reduce the size and progress of your cancer and ease any symptoms.

• #26 Immunotherapy for Unresectable Small Bowel Adenocarcinoma: A Case Series | In Vivo

  https://iv.iiarjournals.org/content/38/1/518

  Background/Aim: The efficacy of systemic therapy for unresectable small bowel adenocarcinoma that is refractory to fluoropyrimidines and oxaliplatin has not yet been established because of the rarity of this cancer. […] Although immunotherapy with anti-PD-1 antibodies has shown robust efficacy in the treatment of esophagogastric adenocarcinoma, its effectiveness in small bowel adenocarcinoma remains unclear. […] Treatment with immune checkpoint inhibitors is effective for refractory small bowel adenocarcinoma, irrespective of the microsatellite status. […] Here, we present two cases of metastatic or unresectable SBA treated with ICIs. These cases demonstrate the efficacy of ICIs for refractory SBA, regardless of MSI status. […] In conclusion, ICIs demonstrated efficacy and appeared to be an important treatment option for metastatic SBA, regardless of MSI status. […] Treatment with immune checkpoint inhibitors was effective in treating refractory small bowel adenocarcinoma, irrespective of the microsatellite status.

• #27 Treatment for advanced bowel cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/bowel-cancer/treatment-for-advanced-bowel-cancer

  Different treatments can be used to treat advanced bowel cancer. The main treatment is chemotherapy. Other treatment options include surgery, radiotherapy, targeted therapy and immunotherapy. […] Your treatment will depend on: where the cancer is, the treatment you have already had, your general health, the results of tests on the bowel cancer cells, your preferences. […] It is sometimes possible to control advanced bowel cancer for a long time. In some people, it might be possible to cure the advanced bowel cancer. Your doctors can talk to you about the aim of your treatment. […] If the cancer is only in 1 area of the body, your doctors may suggest treatment with surgery, radiotherapy or ablation. Ablation uses extreme temperatures to destroy cancer cells. […] Different drug treatments can be used to treat advanced bowel cancer. The main drug treatment is chemotherapy. Other drug treatments for advanced bowel cancer include targeted therapy and immunotherapy. Your doctors may give you targeted therapy with chemotherapy.

• #27 Treatment for advanced bowel cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/bowel-cancer/treatment-for-advanced-bowel-cancer

  Surgery is sometimes used to remove a secondary cancer or to help with symptoms caused by the cancer. […] Chemotherapy is the main drug treatment for advanced bowel cancer. Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. […] Targeted therapy drugs target something in or around a cancer cell that is helping it grow and survive. […] Immunotherapy drugs use the immune system to find and attack cancer cells. Some may be used to treat advanced bowel cancer. […] Ablation uses extreme temperatures to destroy cancer cells. […] Embolisation is a way of cutting off the blood supply to the tumour.

• #28 Small Intestine Cancer Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65986/

  This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of small intestine cancer. […] As in other gastrointestinal malignancies, the predominant modality of treatment is surgery when resection is possible, and cure relates to the ability to completely resect the cancer. […] Treatment options for resectable primary disease include radical surgical resection. […] For unresectable primary disease, options include surgical bypass of obstructing lesion, palliative radiation therapy, and clinical trials evaluating methods to improve local control, such as the use of radiation therapy with radiosensitizers with or without systemic chemotherapy. […] For unresectable metastatic disease, clinical trials evaluating the value of new anticancer drugs and biological therapy (phase I and phase II studies) are recommended.

• #28 Small Intestine Cancer Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65986/

  For metastatic adenocarcinoma or leiomyosarcoma, no standard effective chemotherapy exists for patients with recurrent metastatic adenocarcinoma or leiomyosarcoma of the small intestine. […] These patients should consider enrolling in phase I or II clinical trials evaluating new anticancer drugs or biological therapy. […] For locally recurrent disease, treatment options include surgery, palliative radiation therapy, palliative chemotherapy, and clinical trials evaluating ways of improving local control, such as the use of radiation therapy with radiosensitizers with or without systemic chemotherapy.

• #29 Small Intestine Cancer | UCSF Department of Surgery

  https://surgery.ucsf.edu/condition/small-intestine-cancer

  Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. […] Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. […] New types of treatment are being tested in clinical trials. […] Treatment for small intestine cancer may cause side effects. […] Patients may want to think about taking part in a clinical trial. […] Treatment of small intestine adenocarcinoma will be surgery to remove the tumor and some of the normal tissue around it. […] Treatment of small intestine adenocarcinoma that cannot be removed by surgery may include surgery to bypass the tumor, radiation therapy as palliative therapy to relieve symptoms and improve the patient’s quality of life, a clinical trial of radiation therapy with radiosensitizers, with or without chemotherapy, a clinical trial of new anticancer drugs, a clinical trial of immunotherapy.

• #29 Small Intestine Cancer | UCSF Department of Surgery

  https://surgery.ucsf.edu/condition/small-intestine-cancer

  Treatment of small intestine leiomyosarcoma will be surgery to remove the tumor and some of the normal tissue around it. […] Treatment of recurrent small intestine cancer that has spread to other parts of the body is usually a clinical trial of new anticancer drugs or immunotherapy. […] Treatment of locally recurrent small intestine cancer may include surgery, radiation therapy or chemotherapy as palliative therapy to relieve symptoms and improve the patient’s quality of life.

• #30 Small Intestine Cancer | Vanderbilt-Ingram Cancer Center

  https://vicc.org/cancer-info/adult-small-intestine-cancer

  Treatment of small intestine adenocarcinoma that cannot be removed by surgery may include the following: Surgery, Radiation therapy as palliative therapy to relieve symptoms and improve the patient’s quality of life, A clinical trial of radiation therapy with radiosensitizers, with or without chemotherapy, A clinical trial of new anticancer drugs, A clinical trial of immunotherapy. […] Treatment of recurrent small intestine cancer that has spread to other parts of the body is usually a clinical trial of new anticancer drugs or immunotherapy. […] Treatment of locally recurrent small intestine cancer may include the following: Surgery, Radiation therapy or chemotherapy as palliative therapy to relieve symptoms and improve the patient’s quality of life.

• #31 Small Intestine Adenocarcinoma > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/small-intestine-adenocarcinoma

  Treatment includes surgery, chemotherapy, radiation, immunotherapy. […] Whenever possible, surgery to remove the cancer is the preferred treatment for many types of small intestine cancer, including adenocarcinoma. Typically, doctors remove the tumor, some healthy surrounding tissue, and lymph nodes. Sometimes, when the cancer is in the duodenum, a segment of the pancreas is also removed. Often, people receive chemotherapy after surgery, with or without radiation. […] If small intestine cancer has spread to other body parts, called metastatic disease, the patient may receive chemotherapy or immunotherapy to help the body’s immune system fight the cancer, or a combination of these therapies. Rarely, surgery is sometimes used in treating small intestine adenocarcinoma if it has spread to other body parts. […] The teams at Yale Cancer Center and Smilow Cancer Hospital use a multidisciplinary approach when treating small intestine adenocarcinomas, including surgical oncologists, colorectal surgeons, medical oncologists, radiation oncologists, and gastroenterologists.

• #32

  https://www2.hse.ie/conditions/bowel-cancer/treatment/

  If you’re diagnosed with bowel cancer, a team of specialists will work together to give you the best treatment and care. […] When deciding what treatment is best for you, your care team will consider: the type and size of the cancer, your general health, if the cancer has spread to other parts of your body, your genes, your age and general health. […] Surgery is usually the main treatment for bowel cancer. […] Other treatments include: radiotherapy, chemotherapy, immunotherapy, targeted therapy. […] If your cancer is found early, surgery can often cure it. But there is sometimes a risk that your cancer could come back. […] If colon cancer is at a very early stage, your surgeon may be able to remove the cancer from the colon wall with a small bit of healthy tissue around it. This is called a local excision.

• #32

  https://www2.hse.ie/conditions/bowel-cancer/treatment/

  Bowel cancer surgery has many of the same risks as other major surgery, including: bleeding, infection, blood clots, heart or breathing problems. […] Different types of surgery also have different risks. […] Radiotherapy is not usually used for colon cancer. It may be used for rectal cancer. […] Radiotherapy before surgery shrinks rectal cancers and increases the chances of complete removal. […] If you get radiotherapy after surgery it is to kill small amounts of the cancer that may be left. […] Your care team may recommend treatment with cancer medicines. These will be to either kill or slow the growth of cancer cells. […] Chemotherapy uses medicines to kill cancer cells. […] Immunotherapy medicines can either: use your immune system to find and kill cancer cells, boost your immune system and help it work better to fight cancer cells. […] Targeted therapy uses medicines to find and attack cancer cells.

• #33 Treatment for bowel cancer – NHS

  https://www.nhs.uk/conditions/bowel-cancer/treatment/

  The treatment you’ll have for bowel cancer depends on: […] You may be offered a combination of treatments including surgery, chemotherapy, radiotherapy, and targeted medicines. […] Surgery may be carried out to remove cancer from the bowel. Part or all of the bowel around the cancer may also need to be removed. […] Chemotherapy is medicine that kills cancer cells. […] You may have chemotherapy for bowel cancer: after surgery to try to stop the cancer coming back, if you’re unable to have surgery, if cancer has spread to other parts of your body. […] Radiotherapy uses radiation to kill cancer cells. A machine is used to target beams of radiation directly at tumours. […] You may have radiotherapy for bowel cancer if: you have cancer in your rectum, the cancer has spread to other parts of your body.

• #33 Treatment for bowel cancer – NHS

  https://www.nhs.uk/conditions/bowel-cancer/treatment/

  Targeted medicines kill cancer cells. Immunotherapy is where medicines are used to help your immune system kill cancer. […] Targeted medicines or immunotherapy are sometimes used to treat advanced bowel cancer that has spread to other parts of the body. […] If you’ve been diagnosed with advanced bowel cancer, it may be hard to treat and not possible to cure. […] The aim of treatment will be to slow down the growth and spread of the cancer, to help with the symptoms, and help you live longer. […] You’ll be referred to a team of doctors and nurses called a symptom control team or palliative care team. […] They will help you to manage your symptoms and make you feel more comfortable.

• #34 Treating Cancer in the Intestine | Memorial Cancer Institute

  https://www.mhs.net/services/cancer-care/conditions-treatments-and-services/gastrointestinal-cancer/duodenal-and-small-intestine-cancer

  We also may recommend chemotherapy or radiation therapy. Chemotherapy is a medication that is injected or swallowed to destroy cancer cells, and we offer several types. External-beam radiation therapy is often effective against small intestine cancer. A specialized machine aims high-energy beams directly at the tumor. […] Throughout your cancer journey, we provide exceptional supportive care. This may include: Dietitians to help you maximize your nutrition, Pain management experts to keep you comfortable, Palliative care specialists to help you manage symptoms and make treatment decisions, Psychologists to help you cope with diagnosis and treatment. […] When you come to Memorial for diagnosis and treatment of small intestine cancer, youll find: Expert care: Our oncologists and surgeons are board certified and fellowship trained in gastrointestinal cancers. This means they have the highest level of knowledge and training and stay up to date on the latest research.

• #35 Treatment for Bowel Cancer | Cancer Council NSW

  https://www.cancercouncil.com.au/bowel-cancer/treatment/

  Some people may have radiation therapy or chemotherapy on its own before surgery. […] After surgery you may have further chemotherapy. […] Prehabilitation may improve your strength, help you cope with side effects and improve treatment. […] You may be given iron as tablets or injections to increase your iron levels and red blood cell count (haemoglobin level) before starting treatment. […] If you smoke, you will be encouraged to stop before surgery. […] If it’s hard to eat enough, a dietitian can suggest ways to limit weight loss, reduce blockages and make bowel movements easier. […] Talk to your doctor about how much alcohol you drink. […] Exercise will help build up your strength for recovery.

• #36 Treating Small Intestine Cancer (Adenocarcinoma) | American Cancer Society

  https://www.cancer.org/cancer/types/small-intestine-cancer/treating.html

  Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the-art cancer treatment. […] Complementary methods are treatments that are used along with your regular medical care. Alternative treatments are used instead of standard medical treatment. […] Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known (or not known) about the method, which can help you make an informed decision. […] Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. […] For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. […] Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.

• #37 Treatment Options for People with Advanced Small Bowel Cancer | SWOG

  https://www.swog.org/patients/trials-open-patients/treatment-options-people-advanced-small-bowel-cancer

  This trial will test 2 treatments for a type of small bowel cancer called adenocarcinoma. This cancer is rare, and there is no standard treatment for it yet. […] The study treatments have been approved by the Food and Drug Administration (FDA) for use in other cancers. Researchers want to find out if they also work for people with small bowel cancer. […] Doctors often treat small bowel cancer with treatments that are used for similar cancers. But there hasnt been enough research yet to determine the best treatment approach. […] This trial is a chance to find out if the study treatments work against small bowel cancer. If both study treatments work, the trial will help doctors learn which treatment is better for patients. […] Your doctor will not have control over which group you will be assigned to. This helps make sure the study results are fair and reliable. […] The drug ramucirumab is provided free in the study.

• #38 Small Bowel Cancer Treatment Types | MedStar Health

  https://www.medstarhealth.org/services/small-bowel-cancer-treatment

  There are different types of treatment for patients with small bowel cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. […] A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. […] Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. […] Three types of standard treatment are used: Surgery is the most common treatment of small intestine cancer. […] Surgery to remove part or all of an organ that contains cancer. […] The doctor may remove the section of the small intestine that contains cancer and perform an anastomosis (joining the cut ends of the intestine together).

• #38 Small Bowel Cancer Treatment Types | MedStar Health

  https://www.medstarhealth.org/services/small-bowel-cancer-treatment

  Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery to increase the chances of a cure is called adjuvant therapy. […] Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells. […] Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. […] When possible, treatment of small intestine adenocarcinoma will be surgery to remove the tumor and some of the normal tissue around it. […] Treatment of small intestine adenocarcinoma that cannot be removed by surgery may include the following: Surgery to bypass the tumor, Radiation therapy as palliative therapy to relieve symptoms and improve the patient’s quality of life, A clinical trial of radiation therapy with radiosensitizers, with or without chemotherapy, A clinical trial of new anticancer drugs, A clinical trial of biologic therapy. […] Treatment of recurrent small intestine cancer that has spread to other parts of the body is usually a candidate for a clinical trial of new anticancer drugs or biologic therapy.

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