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Living with cancer·Standard of care

Localised small bowel adenocarcinoma: the decisions you may face

Cancer page →Second-opinion finder →

5 treatment settings, 2 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.

2 options

Endoscopy or enteroscopy with biopsy, CT of chest, abdomen and pelvis, mismatch repair testing and germline assessment.

Guideline
NCCN Guidelines: Small Bowel Adenocarcinoma
The options, in plain words
CT (computed tomography)Standard of care

A CT scan is a fast 3D X-ray that shows the size and shape of tumours and whether they have spread.

  • Fast, ubiquitous
  • Sub-millimetre resolution
  • Standard for RECIST response
Germline (hereditary) testingStandard of care

A test of the DNA you were born with, to find inherited risk genes such as BRCA or Lynch syndrome.

  • Actionable for patient and relatives
  • Cheap
Also referenced:Endoscopy (EGD, EUS, ERCP)Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)Lynch syndrome
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
CT (computed tomography)
  • Anatomic only; cannot distinguish scar from live tumour
  • Radiation dose
  • Poor for brain, marrow, and small peritoneal disease
Germline (hereditary) testing
  • VUS burden
  • Uptake and counselling capacity
Questions to ask about this decision
  1. Between CT (computed tomography) and Germline (hereditary) testing, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (NCCN Guidelines: Small Bowel Adenocarcinoma), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. For my situation (diagnosis and staging), which of the standard options do you recommend and why?
    Why: Guideline options include: Endoscopy or enteroscopy with biopsy, CT of chest, abdomen and pelvis, mismatch repair testing and germline assessment.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

Duodenal tumours

Described in words

Pancreaticoduodenectomy for proximal duodenal tumours; segmental resection for distal duodenal tumours; endoscopic resection only for adenomas.

Guideline
NCCN Guidelines: Small Bowel Adenocarcinoma
The path, in plain words

This setting names no product or technology record yet; the approach above is the standard as written. Ask your team which specific treatments they mean.

Also referenced:Whipple procedure (pancreaticoduodenectomy)Lymphadenectomy (lymph node dissection)
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.

Questions to ask about this decision
  1. Which specific treatments are you proposing for this setting, and what are the alternatives?
    Why: The standard of care here is described in words rather than named products; ask for the names.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (NCCN Guidelines: Small Bowel Adenocarcinoma), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. For my situation (duodenal tumours), which of the standard options do you recommend and why?
    Why: Guideline options include: Pancreaticoduodenectomy for proximal duodenal tumours; segmental resection for distal duodenal tumours; endoscopic resection only for adenomas.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

Jejunal and ileal tumours

Described in words

Segmental resection with wide mesenteric lymphadenectomy; right hemicolectomy for terminal ileal tumours.

Guideline
NCCN Guidelines: Small Bowel Adenocarcinoma
The path, in plain words

This setting names no product or technology record yet; the approach above is the standard as written. Ask your team which specific treatments they mean.

Also referenced:Lymphadenectomy (lymph node dissection)Colectomy
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.

Questions to ask about this decision
  1. Which specific treatments are you proposing for this setting, and what are the alternatives?
    Why: The standard of care here is described in words rather than named products; ask for the names.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (NCCN Guidelines: Small Bowel Adenocarcinoma), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. For my situation (jejunal and ileal tumours), which of the standard options do you recommend and why?
    Why: Guideline options include: Segmental resection with wide mesenteric lymphadenectomy; right hemicolectomy for terminal ileal tumours.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

After surgery

3 optionsCompare side by side →

Observation for stage I and low-risk stage II; adjuvant CAPOX or FOLFOX for stage III and high-risk stage II, extrapolated from colon cancer pending BALLAD.

Guideline
NCCN Guidelines: Small Bowel Adenocarcinoma
The options, in plain words
CAPOX (capecitabine, oxaliplatin)Standard of careCytotoxic regimen

CAPOX pairs the oral fluoropyrimidine capecitabine with intravenous oxaliplatin as a pill-based alternative to FOLFOX. For low-risk stage III colon cancer three months after surgery works as well as six and halves nerve damage; it is also standard in gastric cancer, with hand-foot syndrome as its price.

FOLFOX (5-FU, leucovorin, oxaliplatin)Standard of careCytotoxic regimen

FOLFOX is the workhorse chemotherapy combination for bowel cancer, used after surgery to cure and in advanced disease as the backbone that targeted drugs are added to.

Cytotoxic chemotherapyStandard of care

Cytotoxic chemotherapy drugs (platinums, antimetabolites, microtubule agents and topoisomerase inhibitors) kill rapidly dividing cells by damaging DNA or the mitotic spindle. They still cure testicular cancer, lymphoma and leukaemia, and they are the warhead inside antibody-drug conjugates, but a narrow margin between effective and toxic doses is their limitation.

  • Curative in several cancers
  • Cheap, generic
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
Cytotoxic chemotherapy
  • Narrow therapeutic index
  • Resistance via efflux pumps and DNA repair
Questions to ask about this decision
  1. Between CAPOX (capecitabine, oxaliplatin), FOLFOX (5-FU, leucovorin, oxaliplatin) and Cytotoxic chemotherapy, which do you recommend for me, and what about my case would make you choose differently?
    Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (NCCN Guidelines: Small Bowel Adenocarcinoma), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. For my situation (after surgery), which of the standard options do you recommend and why?
    Why: Guideline options include: Observation for stage I and low-risk stage II; adjuvant CAPOX or FOLFOX for stage III and high-risk stage II, extrapolated from colon cancer pending BALLAD.
  6. Am I a candidate for CAPOX (capecitabine, oxaliplatin), FOLFOX (5-FU, leucovorin, oxaliplatin), and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

One path named

CT and CEA every six to twelve months; endoscopic surveillance of the remaining duodenum in FAP.

Guideline
NCCN Guidelines: Small Bowel Adenocarcinoma
The path, in plain words
CT (computed tomography)Standard of care

A CT scan is a fast 3D X-ray that shows the size and shape of tumours and whether they have spread.

  • Fast, ubiquitous
  • Sub-millimetre resolution
  • Standard for RECIST response
Also referenced:Endoscopy (EGD, EUS, ERCP)
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
CT (computed tomography)
  • Anatomic only; cannot distinguish scar from live tumour
  • Radiation dose
  • Poor for brain, marrow, and small peritoneal disease
Questions to ask about this decision
  1. Is CT (computed tomography) the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
    Why: A single standard does not mean a single choice; timing and trials are decisions too.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. Does your recommendation follow the current guideline (NCCN Guidelines: Small Bowel Adenocarcinoma), and if it departs from it, why?
    Why: Departures from guidelines are sometimes right for an individual; they should be explained.
  5. For my situation (surveillance), which of the standard options do you recommend and why?
    Why: Guideline options include: CT and CEA every six to twelve months; endoscopic surveillance of the remaining duodenum in FAP.

Add these to your appointment list, or take the full question set for this cancer.

How to read this page. Options and results come from OnCo records with their sources; the settings are the standard-of-care rows on the cancer page, and the lines of therapy are on the sequencing grid. Where a setting names one path, the choice is usually about timing, trials and where to be treated: see expert centres. OnCo is orientation, not medical advice.