Chemotherapy for Small Intestine Adenocarcinoma
Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or a muscle or taken by mouth to kill cancer cells. Because these drugs enter the bloodstream and can reach cancer cells anywhere in the body, this treatment can be useful for cancers that have metastasized (spread). But small intestine adenocarcinoma does not seem to be very sensitive to chemotherapy. This is why chemo is not often part of the main treatment for this cancer. Instead, it may be used when the cancer has spread to other organs.
When chemo is given after the tumor is removed with surgery, it’s called adjuvant treatment. In this setting, the chemo is meant to get rid of the cancer cells that are left after surgery (but that are too small to see). This lowers the chance that the cancer will come back later. Adjuvant chemo is often used for colon cancer, but it is not known if it works as well for small intestine cancer.
Some of the chemo drugs that can be used include:
- Capecitabine (Xeloda®)
- 5-fluorouracil (5-FU)
- Irinotecan (Camptosar®, CPT-11)
5-FU is often given with a vitamin-like drug called leucovorin, which helps it work better.
Because small intestine cancer is rare, only a small number of patients have been treated with chemo. This makes it hard to know which drugs work best. Some of the drug combinations that seem to work in advanced small intestine cancer include
- Capecitabine and oxaliplatin (called CAPOX)
- 5-FU and leucovorin with oxaliplatin (FOLFOX)
- 5-FU and leucovorin with irinotecan (FOLFIRI).
Chemo drugs kill cancer cells but also damage some normal cells, causing some side effects. Your health care team will pay careful attention to try and avoid or lessen side effects. These depend on the type of drugs, amount taken, and length of treatment. Common temporary side effects might include
- Nausea and vomiting
- Loss of appetite
- Loss of hair
- Mouth sores.
Chemotherapy can also damage the blood-producing cells of the bone marrow, so you may have low blood cell counts. This can lead to:
- An increased risk of infection (caused by a shortage of white blood cells)
- Bleeding or bruising after minor cuts or injuries (caused by a shortage of blood platelets)
- Fatigue (tiredness) or shortness of breath (caused by low red blood cell counts)
Along with these, some other side effects can be seen with certain medicines, for example:
Hand-foot syndrome can occur during treatment with capecitabine or 5-FU (when given as an infusion). This starts out as redness in the hands and feet, which can then progress to pain and sensitivity in the palms and soles. If it worsens, blistering or skin peeling can occur, sometimes leading to open, painful sores. There is no specific treatment, although some creams may help. These symptoms gradually get better when the drug is stopped or the dose is decreased. The best way to prevent severe hand-foot syndrome is to tell your doctor when symptoms first come up, so that the drug dose can be changed.
Neuropathy (painful nerve damage) is a common side effect of oxaliplatin. Symptoms include numbness, tingling, and even pain in the hands and feet. It can also cause patients to have intense sensitivity to hot and cold in the throat and esophagus (the tube connecting the throat to the stomach). This can cause problems (such as pain) swallowing liquids. If you will be getting oxaliplatin, ask your doctor about side effects beforehand, and let him or her know right away if you develop numbness and tingling or other side effects. More information about neuropathy can be found in Peripheral Neuropathy Caused by Chemotherapy.
Diarrhea is a common side effect with many of these drugs, but can be particularly bad with irinotecan. It needs to be treated right away – at the first loose stool – to prevent severe dehydration. This often means taking drugs like loperamide (Imodium®). If you are on a chemo drug that is likely to cause diarrhea, your doctor will give you instructions on what drugs to take and how often to take them to control this symptom.
Most side effects are short-term and tend to go away after treatment is finished. Some, such as hand and foot numbness, may persist for a long-time. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting. Do not hesitate to discuss any questions about side effects with the cancer care team.
You should report any side effects or changes you notice while getting chemo to your medical team so that they can be treated promptly. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.
For more information about chemo and its side effects, see Chemotherapy.
Last Medical Review: April 30, 2014 Last Revised: February 9, 2016