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This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of small intestine cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
CONTENTS
- General Information About Small Intestine Cancer
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Incidence and Mortality
Estimated new cases and deaths from small intestine cancer in the United States in 2020:[ 1 ]
Adenocarcinoma, lymphoma, sarcoma, and carcinoid tumors account for the majority of small intestine malignancies, which, as a whole, account for only 4% of all gastrointestinal malignancies.[ 2 ][ 3 ][ 4 ][ 5 ]
Follow-up and Survivorship
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.
Carcinoid tumors of the small intestine are covered elsewhere as a separate cancer entity. (Refer to the PDQ summary on Gastrointestinal Carcinoid Tumor Treatment [Adult] for more information.)
参考文献- American Cancer Society: Cancer Facts and Figures 2020. Atlanta, Ga: American Cancer Society, 2020. Available online. Last accessed January 17, 2020.[PUBMED Abstract]
- Chamberlain R, Ghalyaie N, Patil S: Small bowel cancer. In: DeVita VT Jr, Lawrence TS, Rosenberg SA, et al., eds.: DeVita, Hellman, and Rosenberg’s Cancer : Principles & Practice of Oncology. 11th ed. Philadelphia, Pa: Wolters Kluwer, 2019, pp 884-94.[PUBMED Abstract]
- Serour F, Dona G, Birkenfeld S, et al.: Primary neoplasms of the small bowel. J Surg Oncol 49 (1): 29-34, 1992.[PUBMED Abstract]
- Matsuo S, Eto T, Tsunoda T, et al.: Small bowel tumors: an analysis of tumor-like lesions, benign and malignant neoplasms. Eur J Surg Oncol 20 (1): 47-51, 1994.[PUBMED Abstract]
- Chow JS, Chen CC, Ahsan H, et al.: A population-based study of the incidence of malignant small bowel tumours: SEER, 1973-1990. Int J Epidemiol 25 (4): 722-8, 1996.[PUBMED Abstract]
- Cellular Classification of Small Intestine Cancer
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Tumors that occur in the small intestine include the following:
Approximately 25% to 50% of the primary malignant tumors in the small intestine are adenocarcinomas, and most occur in the duodenum.[ 1 ] Small intestine carcinomas may occur synchronously or metachronously at multiple sites.
Leiomyosarcomas occur most often in the ileum.
Some 20% of malignant lesions of the small intestine are carcinoid tumors, which occur more frequently in the ileum than in the duodenum or jejunum and may be multiple.
It is uncommon to find malignant lymphoma as a solitary small intestine lesion.
参考文献- Small Intestine. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 221–34.[PUBMED Abstract]
- Stage Information for Small Intestine Cancer
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The treatment sections of this summary are organized according to histopathologic type rather than stage.
AJCC Stage Groupings and TNM Definitions
The American Joint Committee on Cancer (AJCC) has designated staging by TNM (tumor, node, metastasis) classification to define small intestine cancer. This staging classification applies only to adenocarcinomas arising in the nonampullary duodenum and small intestine. Nonadenocarcinomas arising in the small intestine should have a TNM assigned but are not assigned a stage classification.[ 1 ]
Table 1. Definitions of Primary Tumor (T)a T Category T Criteria aReprinted with permission from AJCC: Small Intestine. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp 221–34. bFor T3 tumors, the nonperitonealized perimuscular tissue is, for the jejunum and ileum, part of the mesentery and, for the duodenum in areas where serosa is lacking, part of the interface with the pancreas. TX Primary tumor cannot be assessed. T0 No evidence of primary tumor. Tis High-grade dysplasia/carcinoma in situ. T1 Tumor invades the lamina propria or submucosa. −T1a Tumor invades the lamina propria. −T1b Tumor invades the submucosa. T2 Tumor invades the muscularis propria. T3 Tumor invades through the muscularis propria into the subserosa, or extends into nonperitonealized perimuscular tissue (mesentery or retroperitoneum) without serosal penetration.b T4 Tumor perforates the visceral peritoneum or directly invades other organs or structures (e.g., other loops of small intestine, mesentery of adjacent loops of bowel, and abdominal wall by way of serosa; for duodenum only, invasion of pancreas or bile duct). Table 2. Definitions of Regional Lymph Node (N)a N Category N Criteria aReprinted with permission from AJCC: Small Intestine. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp 221–34. NX Regional lymph nodes cannot be assessed. N0 No regional lymph node metastasis. N1 Metastasis in one or two regional lymph nodes. N2 Metastasis in three or more regional lymph nodes. Table 3. Definitions of Distant Metastasis (M)a M Category M Criteria aReprinted with permission from AJCC: Small Intestine. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp 221–34. M0 No distant metastasis. M1 Distant metastasis present. Table 4. Prognostic Stage Groups for Adenocarcinomaa Stage T N M T = primary tumor; N = regional lymph node; M = distant metastasis. aReprinted with permission from AJCC: Small Intestine. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp 221–34. 0 Tis N0 M0 I T1−2 N0 M0 IIA T3 N0 M0 IIB T4 N0 M0 IIIA Any T N1 M0 IIIB Any T N2 M0 IV Any T Any N M1 参考文献- Small Intestine. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 221–34.[PUBMED Abstract]
- Small Intestine Adenocarcinoma Treatment
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Standard treatment options:
- For resectable primary disease:
- For unresectable primary disease:
Treatment options under clinical evaluation:
- For unresectable primary disease:
- For unresectable metastatic disease:
Current Clinical Trials
Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
参考文献- Rose DM, Hochwald SN, Klimstra DS, et al.: Primary duodenal adenocarcinoma: a ten-year experience with 79 patients. J Am Coll Surg 183 (2): 89-96, 1996.[PUBMED Abstract]
- North JH, Pack MS: Malignant tumors of the small intestine: a review of 144 cases. Am Surg 66 (1): 46-51, 2000.[PUBMED Abstract]
- Small Intestine Leiomyosarcoma Treatment
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Standard treatment options:
- For resectable primary disease:
- For unresectable primary disease:
- For unresectable metastatic disease:
Treatment options under clinical evaluation:
Current Clinical Trials
Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
- Recurrent Small Intestine Cancer Treatment
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Standard treatment options:
- For metastatic adenocarcinoma or leiomyosarcoma:
- For locally recurrent disease:
Current Clinical Trials
Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
- Changes to This Summary (01/29/2020)
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The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
General Information About Small Intestine Cancer
Updated statistics with estimated new cases and deaths for 2020 (cited American Cancer Society as reference 1).
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.
- About This PDQ Summary
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Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of small intestine cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's Email Us. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
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The preferred citation for this PDQ summary is:
PDQ® Adult Treatment Editorial Board. PDQ Small Intestine Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/small-intestine/hp/small-intestine-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389423]
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