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Small intestine cancers are often found because of signs or symptoms a person is having. But these symptoms aren’t usually enough to know for sure if a person has a small intestine cancer or some other type of health problem. If a tumor is suspected, exams and tests will be needed to confirm the diagnosis.
When a doctor takes your medical history, you will be asked about your symptoms, possible risk factors, family history, and other medical conditions. The doctor will then examine you, focusing on your abdomen looking for any swelling or sounds of the bowel trying to overcome a blockage.
If your doctor suspects a small intestine cancer, they will likely order some blood tests, such as:
Imaging tests use x-rays, magnetic fields, or radioactive substances to create pictures of the inside of the body. Imaging tests might be done for a number of reasons, including:
Most patients who have or may have a small intestine tumor will have one or more of these tests.
For these tests, a liquid containing barium (a chalky substance) is put into the body to coat the lining of the gastrointestinal (GI) tract, and then x-rays are taken. The barium helps outline any abnormal areas in the esophagus, stomach, and intestines, making them more visible. These x-rays are most often used to look for tumors in the upper or lower parts of the GI tract, but they are less helpful in finding small intestine tumors. Barium tests were used more often before endoscopy was available (see below).
A CT scan uses x-rays to make detailed cross-sectional images of your body. Unlike a regular x-ray, a CT scan creates detailed images of the soft tissues in the body.
CT scans are often done if you have abdominal (belly) pain to try to find the source of the problem. Although small intestine tumors may not always be seen well on a CT, these scans are good at showing some of the problems that these tumors can cause (like an obstruction or perforation). CT scans can also help find areas of cancer spread.
CT enteroclysis: This test is sometimes used to get a better view of the intestine than a standard CT can provide. Before the scan, a thin tube is passed down your nose or mouth and down to the small intestine. A large volume of a liquid contrast agent is then put into the tube, which helps expand the intestine and makes it easier to see on a CT scan.
CT-guided needle biopsy: CT scans can also be used to guide a biopsy needle precisely into an abnormal area that could be cancer spread. For this procedure, called a CT-guided needle biopsy, you will stay on the CT scanning table while the doctor moves a biopsy needle through the skin and toward the location of the mass/tumor. CT scans are repeated until the needle is within the mass. Small samples of tissue are then removed and looked at under a microscope.
Like CT scans, MRI scans show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays.
MRI scans can sometimes be useful in people with suspected small intestine tumors, because they can show a lot of details in soft tissues. But a CT scan is often done instead, as it is typically an easier test to have done.
MR enteroclysis: This test is sometimes used to get a better view of the intestine than a standard MRI can provide. Before the scan, a thin tube is passed down the nose or mouth and down to the small intestine. A large volume of a liquid contrast agent is then put into the tube, which helps expand the intestine and makes it easier to see on an MRI.
For an endoscopy, the doctor puts a flexible, lighted tube (endoscope) with a tiny video camera on the end into the body to see the inner lining of the GI tract. If abnormal areas are found, small pieces can be biopsied (removed) through the endoscope.
Upper endoscopy (also called esophagogastroduodenoscopy or EGD) is used to look at the esophagus, stomach and duodenum (the first part of the small intestine). The endoscope is put in through the mouth, and then passes through the esophagus, into the stomach, and then into the first part of the small intestine. If the doctor sees any abnormal areas, small pieces of tissue can be removed to be looked at under a microscope to see if cancer is present.
Most people having this test are given medicine to make them sleepy. If this is the case, you will usually need someone to take you home (not just a cab or rideshare service).
This test is helpful in looking at the first part of the small intestine. Other tests, such as capsule endoscopy and double-balloon enteroscopy, are needed to look at the rest of the small intestine.
This procedure does not actually use an endoscope. Instead, you will swallow a capsule (about the size of a large vitamin pill) that has a light and a very small camera. Like any other pill, the capsule goes through the stomach and into the small intestine. As it travels through the small intestine (usually over about 8 hours), it takes thousands of pictures. The camera sends the images to a device that you wear around the waist while going about your normal daily activities. The pictures can then be downloaded onto a computer, where the doctor can look at them as a video. The capsule passes out of the body during a normal bowel movement and is flushed away.
Most of the small intestine can't be viewed with an upper endoscopy because it is too long (about 20 feet) and has too many curves. Double-balloon enteroscopy gets around these problems by using a special endoscope that is made up of 2 tubes, one inside the other.
You are given intravenous (IV) medicine to help you relax, or even general anesthesia (so that you are asleep). The endoscope is then inserted either through the mouth or the anus, depending on if there is a specific part of the small intestine to be looked at.
Once in the small intestine, the inner tube, which is an endoscope, is pushed forward a small distance, and then a balloon at its end is inflated to anchor it. Then the outer tube is pushed forward to near the end of the inner tube and it is then anchored in place with a balloon. This process is repeated over and over, letting the doctor see the intestine a foot at a time.
This test can sometimes be helpful when done along with capsule endoscopy. An advantage of this test over capsule endoscopy is that the doctor can biopsy anything that looks abnormal.
Because you will be given medicine to make you sleepy for the procedure, usually someone you know will need to drive you home (not just a cab or rideshare service).
Procedures such as endoscopy and imaging tests can find areas that look like cancer, but the only way to know for certain is to do a biopsy. In a biopsy, a piece of the abnormal area is removed and looked at under a microscope.
There are different ways to take biopsy samples of an intestinal tumor.
Doctors can usually tell if a biopsy sample contains cancer (adenocarcinoma) cells by looking at it under a microscope. But other tests might be done on the samples as well.
For example, the cancer cells might be tested for certain gene changes that could affect treatment options. Changes in mismatch repair (MMR) genes, or another genetic change known as microsatellite instability (MSI), make it more likely that the cancer might respond to treatment with immunotherapy drugs called checkpoint inhibitors.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Chamberlain RS, Krishnaraj M, Shah SA. Chapter 54: Cancer of the Small Bowel. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.
Cusack JC, Overman MJ. Diagnosis and staging of small bowel neoplasms. UpToDate. Accessed at www.uptodate.com/contents/diagnosis-and-staging-of-small-bowel-neoplasms on January 17, 2018.
Doyon L, Greenstein A, Greenstein A. Chapter 76: Cancer of the Small Bowel. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier; 2014.
Last Revised: February 8, 2018
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