There is no specific or strict guidelines for small bowel cancer, and it is dependent on applying methods from colon and stomach cancer treatment protocols.

Surgery

Surgery is commonly applied before adjuvant chemotherapy for 6 months. This is for node-positive and resected disease. It is also useful for stage II patients, T3, T4 node negative, but it depends on patients’ clinicopathological features, and mismatch repair (MMR) status. There are several considerations before the operation (Mangla, 2023).

Survival rate may depend on the presence of lymph nodes. Early-stage cancer in the jejunum and ileum, with more than 8 lymph nodes when removed. This increases the survival rate to 81.6% compared to 93.3% of colon cancer. This suggests there is differences in these cancers (Khosla et al., 2022).

Removal of the lymph nodes and complete resection of the tumour.

The tumour needs to be a minimum of 5 cm in the proximal and distal margins. This can be specific depending on the anatomical site.

Segmental and lymph node dissection: This can be performed in tumours of the duodenum, jejunum, and ileum.

Laparoscopic segmental colectomy

Laparoscopic segmental colectomy with extensive D3 lymph node dissection (ED3LND), for right-sided transverse colon cancer (TCC) where more lymph nodes were retrieved (Huang, 2024). The transverse colon is between the hepatic and splenic flexures.

Right Hemicolectomy

Right hemicolectomy or ileo-caecal resection that may also include the ileocolic artery and associated lymph nodes for tumours of the ileum. The procedure involves removing the caecum and the distal part of the small bowel, referred to as the terminal ileum. Compared to segmental colectomy, right hemicolectomy has a longer specimen, more lymph nodes harvested, and a greater risk of tumour and functional damage (Huang, 2024).

Pancreaticoduodenectomy

Tumours of the duodenum that have extended to the pancreas or ampulla alongside associated lymph nodes. Whipple procedure is performed where the head of the pancreas (right side) is closest to the duodenum, the duodenum, gall bladder (stores bile), and common bile duct (carries bile from the liver to the gall bladder and from the gall bladder to the small intestine) (Mangla, 2023)

Mastastasectomy

Metastatic cases of small bowel cancer.

Chemotherapy

The combination of several chemotherapies has better efficacy and efficiency rate in eradicating cancer cells than a single-agent regimen. The two predominant chemotherapies applied in patients with small bowel cancer are:

CAPOX

This consists of an analogue of 5-Fluorouracil called Capecitabine and a platinum analogue of cisplatin called oxaliplatin (Khosla et al., 2022).

Please visit Cancer Research UK’s website to find out more about the CAPOX and which cancers it can elicit its function:

FOLFOX

This consists of folinic acid, 5-fluorouracil, and oxaliplatin (Khosla et al., 2022)

Please visit Cancer Research UK to find out more about FOLFOX.

Combining Chemotherapy With Radiotherapy

This is common in cancers in the duodenum with a high rate of recurrence. They are not operable. These are commonly node-positive, advantage T stage, margin-positive, and have inadequate lymph node dissection (Khosla et al., 2022).

Targeted Therapy.

Limited and unclear evidence on the use of Cetuximab and Panitumumab, both candidates for anti-EGFR therapy. Other therapies like Bevacizumab require randomised clinical trials to prove their effectiveness when combined with chemotherapy to improve the overall survival and disease-free survival rates (Khosla et al., 2022). The aim of anti-EGFR therapy is to halt the cellular proliferation of cancer growth and the transcription of target genes that induce tumour invasion and survival.

The mechanism of anti-EGFR therapy (ar.inspiredpencil.com, 2025)

References

Basic Medical Key (2016) Lower Digestive Tract. Available at: https://basicmedicalkey.com/lower-digestive-segment/ (Accessed: 25^th June 2025.

Huang, X. (2024). Laparoscopic segmental colectomy with extensive D3 lymph node dissection for right transverse colon cancer. Journal of International Medical Research, 52(10). doi:https://doi.org/10.1177/03000605241281870.

Khosla, D., Dey, T., Madan, R., Gupta, R., Goyal, S., Kumar, N. and Kapoor, R. (2022). Small bowel adenocarcinoma: An overview. World Journal of Gastrointestinal Oncology, [online] 14(2), pp.413–422.

Mangla, V. (2023) Pancreaticoduodenectomy (Whipple procedure) Available at: https://www.drvivekmangla.com/blog/pancreaticoduodenectomy-whipple-procedure (Accessed: 17^th June 2025)

Pedersen, K.S., Raghav, K. and Overman, M.J. (2019). Small Bowel Adenocarcinoma: Etiology, Presentation, and Molecular Alterations. Journal of the National Comprehensive Cancer Network, 17(9), pp.1135–1141. doi:https://doi.org/10.6004/jnccn.2019.7344. https://jnccn.org/view/journals/jnccn/17/9/article-p1135.xml

Updated June 2025 Next Review June 2027

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