Due to the rarity of these tumours, clinical trials are lacking, and most treatments are based on consensus opinion.
- Resection of the primary and investing mesentery which contains the regional lymph nodes at risk for metastases provides important staging information.
- Based on studies of patients with recurrent disease following complete resection, it is known that small bowel cancers tend to recur systemically. As such, extrapolating from published data for resected node-positive colon cancer, adjuvant chemotherapy with either 5-fluorouracil (5-FU) and oxaliplatin (i.e. FOLFOX) or 5-FU/capecitabine alone may be offered to patients (CAP approval required).
- Patients with primary duodenal cancers are reported to be at higher risk of local recurrence. As such, adjuvant 5-FU-based chemoradiotherapy may be given in addition to a course of systemic chemotherapy.
- Surgical resection and anastomosis or bypass of obstructing or bleeding primary tumours in selected patients
- Endoscopic duodenal stent can be placed to palliate duodenal obstruction.
- Palliative radiation therapy to the duodenum may provide local control.
- Palliative chemotherapy with a 5-FU-based regimen in combination with a platinum compound has shown the best responses in retrospective studies. Any active regimen for either metastatic colon or gastric cancer would be a reasonable choice.
- Options include (all require CAP approval):
- 5-FU and oxaliplatin (FOLFOX)
- Epirubicin, cisplatin, and 5-FU or capecitabine (ECF/ECC)
- 5-FU and cisplatin (GIFUC)
- 5-FU and irinotecan (FOLFIRI)
- infusional 5-FU alone (GIAVFL, GIFUINF)
- The choice and sequence of chemotherapy is determined by disease-related factors, patient factors and patient preferences as assessed by the medical oncologist.
- Consider treatment on a clinical trial, if available.
- Symptom management, best supportive care, and involvement of palliative care services as indicated by patient's clinical status.
