Diagnosis of small intestine cancer

Diagnosing small intestine cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for small intestine cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as small intestine cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of small intestine cancer.

The following tests are commonly used to rule out or diagnose small intestine cancer. Many of the same tests used to diagnose cancer are used to find out the stage, which is how far the cancer has progressed. Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. In taking a health history, your doctor will ask questions about a personal history of:

• symptoms that suggest small intestine cancer
• genetic conditions that increase your risk for developing small intestine cancer
• other cancers, particularly colorectal cancer

Your doctor may also ask about a family history of:

• genetic risk factors for small intestine cancer
• other cancers

A physical exam allows your doctor to look for any signs of small intestine cancer. During a physical exam, your doctor may:

• feel the abdomen for any swelling, pain or lumps
• look at your skin and eyes to see if they are yellow (called jaundice)

Find out more about physical exams.

An x-ray uses small doses of radiation to make an image of the body’s structures on film. An x-ray isn’t generally used to diagnose a tumour in the small intestine. But doctors use it to look for a blockage, or obstruction, in the small intestine when someone has abdominal pain.

Find out more about x-rays.

A computed tomography (CT) scan uses special x-ray equipment to make 3-dimensional and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to look for the cause of pain or swelling in the abdomen, such as a tumour in the small intestine. It is also used to see if a small intestine tumour has grown into other organs or the cancer has spread to nearby lymph nodes.

Find out more about CT scans.

Enteroclysis is a type of x-ray used to look for a tumour in the small intestine. A tube is passed through the nose or mouth, down the throat, through the stomach and into the small intestine. Barium is put into the tube and it flows into the small intestine. X-rays are taken as the barium coats the lining of the small intestine and moves through it. Barium is a thick, chalky liquid that makes structures show up clearly on the x-ray image.

An endoscopy is done to find out what is causing bleeding in the small intestine or to look for a tumour in the small intestine. It allows a doctor to look inside the small intestine using a flexible tube with a light and lens on the end. This tool is called an endoscope. An endoscopy of the small intestine is also called an enteroscopy.

Doctors can pass small tools through the endoscope. They can use these tools to remove polyps. Doctors can also use them to collect samples from abnormal areas to be examined under a microscope (called a biopsy).

The small intestine is very long and has many loops and curves, which make it difficult to examine. Doctors can use different types of endoscopy to examine the entire length of the small intestine.

Push endoscopy lets doctors examine the duodenum, which is the first part of the small intestine nearest the stomach. The doctor passes the endoscope through the mouth, down the throat and through the stomach. The doctor pushes it as far as possible along the duodenum and into the middle part of the small intestine (called the jejunum). A push endoscopy may be done as part of an upper gastrointestinal (GI) series.

Balloon endoscopy uses a special balloon attached to the endoscope. The doctor can blow air into the balloon to push open the walls of the small intestine so the endoscope can move farther along. It can help the doctor better see the walls of the small intestine and any blockage, bleeding or tumors that may be there. A double-balloon endoscopy has 2 balloons attached to the endoscope. The doctor can use these balloons to move the endoscope and instruments.

Capsule endoscopy is also called PillCam endoscopy. It is a newer and less invasive procedure. Instead of having an endoscopy, you swallow a pill-sized capsule that has a tiny video camera and a light. The camera takes pictures as it moves through the gastrointestinal (GI) tract. It sends these pictures to a small recording device that you wear around your waist. It usually takes about 8 hours for the capsule to pass through the GI tract. The capsule is passed out of the body in a bowel movement. The healthcare team downloads the pictures onto a computer for the doctor to look at. If the doctor sees something in the pictures, you will have an endoscopy to collect a sample for biopsy. Capsule endoscopy cannot be used if you have a blockage, or obstruction, in the small intestine.

Biopsy of the small intestine is done during an endoscopy, laparotomy or laparoscopy. The doctor removes tissues or cells from the body so they can be tested in a lab. The report from the lab will confirm whether or not cancer cells are present in the sample.

Find out more about biopsies.

Doctors may use laparotomy or laparoscopy to examine and collect samples from the small intestine. They use these procedures if they can’t use other tests, such as endoscopy, because you have a:

• blocked intestine (called a bowel obstruction)
• mass in the abdomen
• buildup of fluid in the abdomen (called ascites)

Laparotomy is a cut, or incision, to make an opening in the abdomen. Doctors use it so they can look inside the abdomen for signs of cancer or disease. They may also take samples of tissue for biopsy.

Laparoscopy is less invasive than laparotomy. The surgeon makes small cuts in the wall of the abdomen and passes an endoscope through them. Doctors use laparoscopy to examine the intestine and internal organs. They can also take samples for biopsy during laparoscopy.

A CBC measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to check for anemia from long-term, or chronic, bleeding in the small intestine.

Find out more about a complete blood count (CBC).

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can help find abnormalities.

Liver function tests are used to stage small intestine cancer. These tests measure how well the liver is working. Higher levels of certain substances in the blood may mean that small intestine cancer has spread to the liver.

Find out more about blood chemistry tests.

To make the decisions that are right for you, ask your healthcare team questions about diagnosis.