Small Intestine Cancer

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Treating Small Intestine Cancer (Adenocarcinoma)

If you’ve been diagnosed with a small intestine cancer, your cancer care team will discuss your treatment options with you. It’s important to weigh the benefits of each treatment option against the possible risks and side effects.

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This information is about small intestine cancers called adenocarcinomas. To learn about other types of cancer that can start in the small intestine, see Gastrointestinal Carcinoid Tumors, Gastrointestinal Stromal Tumors, or Non-Hodgkin Lymphoma.

Who treats small intestine cancer?

Based on your treatment options, you might have different types of doctors on your treatment team.  These doctors could include:

  • A gastroenterologist: a doctor who treats disorders of the gastrointestinal (GI or digestive) tract
  • A surgical oncologist: a doctor who treats cancer with surgery
  • A radiation oncologist: a doctor who uses radiation to treat cancer
  • A medical oncologist: a doctor who uses chemotherapy and other medicines to treat cancer

You might have many other specialists on your treatment team as well, including physician assistants (PAs), nurse practitioners (NPs), nurses, psychologists, social workers, nutrition specialists, rehabilitation specialists, and other health professionals.

Which treatments are used for small intestine cancer?

The main types of treatment used for small intestine adenocarcinoma are:

Surgery
Chemotherapy
Radiation Therapy
Targeted Therapy
Immunotherapy

Sometimes more than 1 type of treatment is used. The treatment option(s) that are best for you will depend on many factors, including the type, grade, and stage of the cancer, as well as your preferences and overall health.

Treatment approaches for small intestine cancer (adenocarcinoma), based on tumor spread

Treatment of small intestine cancer depends mainly on whether 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. The type of surgery will depend on where the cancer is:

  • If the cancer is in the duodenum (the first part of the small intestine), an extensive operation called a Whipple procedure (pancreaticoduodenectomy) is typically done.
  • If the cancer is in another part of the small intestine, a segmental resection (removing the part of the intestine containing the tumor) is more likely to be done.
  • If the cancer is near the end of the small intestine, part of the large intestine (colon) might need to be removed as well.

If the cancer has grown through the wall of the intestine or spread to nearby lymph nodes, the doctor may recommend adjuvant chemotherapy (chemo) with or without radiation therapy to try to kill any cancer cells that may have been left behind after surgery but were too small to see. The hope is that this treatment will help keep the cancer from coming back (recurring).

Chemo with or without radiation may be given before surgery (known as neoadjuvant therapy). The hope is that this may shrink the tumor and make surgery easier.

A small intestine cancer may be unresectable if it has grown into nearby tissues or spread to other organs and tissues, or if a person isn’t healthy enough for major surgery.

Some people with unresectable cancers still have surgery to treat blocked intestines. This might include removing a large part of the tumor or bypassing the tumor in some way. This type of palliative surgery can often help prevent or relieve symptoms like nausea, vomiting, and abdominal pain.

Whether or not surgery is done, chemotherapy is typically part of treatment. If the cancer is in the lining of the abdomen, chemo might be given right into the abdominal space just after surgery (known as intraperitoneal chemotherapy). Radiation therapy can also be used to treat cancer that has spread, especially to the brain or bones, such as the spine.

Another treatment option for some people might be targeted therapy or immunotherapy.

  • Targeted therapy uses drugs that specifically target a certain mutation found in the cancer cells. 
  • Immunotherapy uses medicines to boost the body’s own immune response against the cancer.

For people whose cancer cells have certain gene changes, such as mismatch repair (MMR) gene mutations or microsatellite instability (MSI), treatment with medicines called checkpoint inhibitors, such as pembrolizumab (Keytruda), might be helpful.

Because there is no generally accepted standard treatment for these advanced cancers, taking part in a clinical trial is also a good option.

Making treatment decisions

It’s important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. It’s also very important to ask questions if there's anything you’re not sure about.

Questions to ask your doctor

When deciding on a treatment plan

  • What are my treatment options?
  • What do you recommend and why?
  • What is the goal of the treatment?
  • Should I get a second opinion? How do I do that? Can you recommend someone?
  • Based on what you’ve learned about my cancer, what is my outlook?
  • How quickly do we need to decide on treatment?
  • What should I do to be ready for treatment?
  • How long will treatment last? What will it be like? Where will it be done?
  • What risks or side effects are there to the treatments you suggest?
  • Will treatment affect my daily activities?
  • How likely is it that the cancer will come back after treatment? Is there anything I can do to lower this risk?

During treatment

  • How will we know if the treatment is working?
  • Is there anything I can do to help manage side effects?
  • What symptoms or side effects should I tell you about right away?
  • How can I reach you (or someone from your office) on nights, holidays, or weekends?
  • Do I need to change what I eat during treatment?
  • Are there any limits on what I can do?
  • Should I exercise? What should I do, and how often?
  • Can you suggest a mental health professional I can see if I start to feel overwhelmed, depressed, or distressed?

Other things to consider

If time allows, consider getting a second opinion to feel more confident about the treatment plan you choose.

Clinical trials study new treatments and may offer access to promising options not widely available. They are also how doctors learn better ways to treat cancer. Ask your doctor about clinical trials you may qualify for.

You may hear about ways to relieve symptoms or treat your cancer such as herbs, diets, acupuncture, massage, or many others. Integrative (holistic) methods are used with standard care, while alternative ones replace it. Some may help with symptoms, but many aren’t proven to work and could even be harmful. Talk with your care team first to make sure they’re safe and won’t interfere with treatment.

Help getting through cancer treatment

People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care.

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. Communicating with your cancer care team is important so you understand your diagnosis, what treatment is recommended, and ways to maintain or improve your quality of life.

Different types of programs and support services may be helpful, and they can be an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help.

The American Cancer Society also has programs and services - including rides to treatment, lodging, and more - to help you get through treatment. Contact the ACS cancer helpline for more information.

Cancer Help

Contact the ACS cancer helpline to get answers and information
Search for resources

Find free or low-cost resources from ACS and other organizations.

Choosing to stop treatment or choosing no treatment at all

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. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.

Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but it’s important to talk to your doctors as you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with your doctor or a member of your supportive care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families.

The treatment information given here is not official policy of the American Cancer Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor. Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask your cancer care team any questions you may have about your treatment options.

side by side logos for American Cancer Society and American Society of Clinical Oncology

Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).

Chamberlain RS, Krishnaraj M, Shah SA. Chapter 54: Cancer of the Small Bowel. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.

Doyon L, Greenstein A, Greenstein A. Chapter 76: Cancer of the Small Bowel. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2019.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Small Bowel Adenocarcinoma. Version 4.2025. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/small_bowel.pdf on Jan 2, 2026. 

Last Revised: February 9, 2026

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.

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