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Research in small intestine cancer
We are always learning more about cancer. Researchers and healthcare professionals use what they learn from research studies to develop better practices that will find and treat small intestine cancer.
The following is a selection of research showing promise for small intestine adenocarcinoma, which is the most common type of small intestine cancer. We’ve included information from PubMed, which is the research database of the National Library of Medicine (NLM). Each research article in PubMed has an identity number (called a PMID) that links to a brief overview (called an abstract). We have also included links to abstracts of the research presented at meetings of the American Society of Clinical Oncology (ASCO), which are held throughout the year. You can find information about ongoing clinical trials in Canada from CanadianCancerTrials.ca and ClinicalTrials.gov. Clinical trials are given an identifier called a national clinical trial (NCT) number. The NCT number links to information about the clinical trial.
Diagnosis and prognosis
A key area of research looks at better ways to diagnose and stage small intestine cancer. Researchers are also trying to find ways to help doctors predict a prognosis (the probability that the cancer can be successfully treated or that it will come back after treatment). The following is noteworthy research into diagnosis and prognosis.
Biomarkers are substances, such as proteins, genes or pieces of genetic material like DNA and RNA, that are found naturally in the body. They can be measured in body fluids like blood and urine or tissue that has been removed from the body. A gene mutation or a change in the normal amount of a biomarker can mean that a person has a certain type of cancer. Biomarkers may also help doctors predict the prognosis or response to treatment in people with small intestine cancer. Researchers are looking at the following biomarkers to see if they can help doctors predict a prognosis for and find out which treatments will benefit a person with small intestine cancer:
- human epidermal growth factor receptor 2 (ERBB2 or HER2) tumour marker (ASCO, Abstract 205)
- programmed death 1 (PD-1) protein (ASCO, Abstract 233)
- thymidylate synthase gene changes (Oncology Reports, PMID 25955097)
- mismatch-repair deficiency (New England Journal of Medicine, PMID 26028255)
Prognostic factors for people treated with chemotherapy may help doctors predict outcomes for small intestine cancer that can’t be removed with surgery. One study looked at factors that predicted longer survival after chemotherapy with FOLFOX6, which is folinic acid (leucovorin), 5-fluorouracil (Adrucil, 5-FU) and oxaliplatin (Eloxatin). It found that performance status, tumours in the middle part of the small intestine (called the jejunum) and a normal carcinoembryonic antigen (CEA) level could predict a longer overall survival in people who received FOLFOX6 chemotherapy (ASCO, Abstract 430).
Find out more about research in diagnosis and prognosis.
Researchers are looking for new ways to improve treatment for small intestine cancer. Advances in cancer treatment and new ways to manage the side effects from treatment have improved the outlook and quality of life for many people with cancer. The following is noteworthy research into treatment for small intestine cancer. Because small intestine cancer is so rare, many of the studies are small and have only a few participants.
Removing lymph nodes during surgery may help improve survival for people with small intestine cancer that has not spread to other parts of the body. A study found that doctors need to remove 9 or more lymph nodes during surgery to find out how far the cancer has spread. People who had 9 or more lymph nodes removed lived longer than people who had fewer than 9 lymph nodes removed (Journal of Gastrointestinal Surgery, PMID 26487334).
Hyperthermic intraperitoneal chemotherapy gives heated chemotherapy drugs directly into the peritoneal cavity in the abdomen. Researchers looked at a group of people who had surgery to remove as much small intestine cancer as possible (called cytoreductive surgery). After surgery, they were given hyperthermic intraperitoneal chemotherapy to treat cancer that wasn’t removed during surgery. Researchers found that this combination increased the length of time that people were expected to survive and could be a treatment option for small intestine cancer that has spread to the peritoneal cavity (Annals of Surgical Oncology, PMID 26717938).
Chemotherapy after surgery (called adjuvant chemotherapy) may be given for stage 1, 2 or 3 small intestine cancer that was completely removed with surgery. However, the role of chemotherapy in this setting remains unknown. Researchers compared a group of people who received adjuvant chemotherapy to a group that did not. Results show that adjuvant chemotherapy significantly improved survival in people with stage 3 small intestine cancer. Another ongoing study is looking at the role of adjuvant chemotherapy for stage 1, 2 and 3 small intestine cancer (NCT02502370). More research is needed to learn how adjuvant chemotherapy may be used with stage 1 and 2 small intestine cancer (Cancer, PMID 26717303).
Adding bevacizumab (Avastin) may improve the effectiveness of the combination chemotherapy already used to treat small intestine cancer that has spread to other parts of the body (metastatic). One study added bevacizumab to either FOLFOX6 or FOLFIRI, which is folinic acid, 5-fluorouracil and irinotecan (Camptosar). Researchers compared people who were given bevacizumab with the chemotherapy combinations to people who were given FOLFOX6 or FOLFIRI alone. Results showed that survival improved slightly for people who were given the chemotherapy combinations with bevacizumab (Clinical Colorectal Cancer, PMID 27247089). Another study combined bevacizumab with capecitabine (Xeloda) and oxaliplatin to treat advanced small intestine cancer. This study found that this combination of drugs was safe, didn’t cause severe side effects and was as effective as other chemotherapy combinations that are used for small intestine cancer (ASCO, Abstract 144).
Learn more about cancer research
Researchers continue to try to find out more about small intestine cancer. Clinical trials are research studies that test new ways to prevent, detect, treat or manage small intestine cancer. Clinical trials provide information about the safety and effectiveness of new approaches to see if they should become widely available. Most of the standard treatments for small intestine cancer were first shown to be effective through clinical trials.
The measure of how well a person is able to perform ordinary tasks and carry out daily activities.
Examples of scales used to evaluate performance status include the Eastern Cooperative Oncology Group (ECOG), World Health Organization (WHO) and the Karnofsky performance status scale.
A protein that is normally found in small amounts in the blood of most healthy people but that can be higher in people who smoke tobacco or have certain types of cancer, particularly colorectal cancer.
CEA can be used as a tumour marker. It is used to monitor a person’s response to treatment for colorectal, breast, lung, stomach or pancreatic cancer, or to see if colorectal cancer has come back (recurred) after treatment.
The space between the parietal peritoneum (the membrane that lines the walls of the abdomen and pelvis) and the visceral peritoneum (the membrane that covers and supports most of the abdominal organs).
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
What’s the lifetime risk of getting cancer?
The latest Canadian Cancer Statistics report shows about half of Canadians are expected to be diagnosed with cancer in their lifetime.