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Small intestine

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Diagnosing small intestine cancer

Diagnosis is the process of finding the cause of a health problem. The process of diagnosis may seem long and frustrating, but it is important for the doctor to rule out other reasons for a health problem before making a cancer diagnosis. Diagnostic tests for small intestine cancer are usually done when:

  • the symptoms of small intestine cancer are present

The doctor suspects small intestine cancer after talking with a person about their health and completing a physical examination

Many of the same tests used to initially diagnose cancer are used to determine the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. Tests may include the following.

Medical history and physical examination

The medical history is a record of present symptoms, risk factors and all the medical events and problems a person has had in the past. The medical history of a person’s family may also help the doctor to diagnose small intestine cancer.

In taking a medical history, the doctor will ask questions about:

  • a personal history of
    • changes in digestion or bowel habits
    • Crohn’s disease
    • celiac disease
    • AIDS
  • a family history of
    • familial adenomatous polyposis (FAP)
    • Lynch syndrome (also called hereditary non-polyposis colorectal cancer, or HNPCC)
    • Peutz-Jeghers syndrome
  • sign and symptoms that may suggest small intestine cancer

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

  • feel the abdomen for
    • lumps
    • bloating or swelling
  • examine the skin and eyes for yellowing (jaundicejaundiceA condition in which the skin and whites of the eyes become yellow and urine is dark yellow.)

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Abdominal x-ray

An x-ray uses small doses of radiation to make an image of the body’s structures on film. A plain (conventional) abdominal x-ray may be done to check for a blockage (obstruction) of the small intestine, but is generally not helpful for diagnosing a small intestine tumour.

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Upper gastrointestinal (GI) series with small bowel follow-through

An upper GI series is also called a barium swallow or a barium study. The person swallows a thick, chalky substance called barium, which coats the inside of the esophagus, stomach and small intestine. X–rays of these organs are taken. The process of taking x-rays as the barium moves through the small intestine is called a small bowel follow-through.

An upper GI series with small bowel follow-through can help identify bleeding, a blockage (obstruction), tumours or other problems in the small intestine. However, it may not always detect a tumour. Also, an upper GI series and small bowel follow-through doesn’t show the depth of a tumour or if the cancer has spread to nearby lymph nodes.

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Enteroclysis involves putting a tube into the nose or mouth, down the throat, through the stomach and into the small intestine. Barium is then put into the tube so it reaches the small intestine. X-rays are then taken as the barium moves through the small intestine. Small intestine tumours are more likely to show up on enteroclysis than on an upper GI series.

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Upper gastrointestinal (GI) endoscopy

An upper GI endoscopy (also called esophagogastroduodenoscopy or EGD) uses a flexible tube with a light and lens on the end (an endoscope) to look inside the GI tract. This procedure allows the doctor to see from the mouth to the upper part of the small intestine. It is used to diagnose the cause of bleeding within the small intestine or look for a tumour.

A small bowel enteroscopy or push enteroscopy, allows the doctor to insert an endoscope through the mouth, down the throat into the esophagus, stomach and then the duodenum. The endoscope is pushed as far as possible into the jejunum.

Small tools can be inserted through the endoscope to remove pieces of tissue (biopsy) from abnormal areas in the duodenum and jejunum. These tissue samples are sent to the laboratory to be checked for cancer cells.

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Capsule endoscopy

Capsule endoscopy is a newer procedure that allows doctors to view the entire small intestine. It is used to find out if a small intestine tumour is the cause of abdominal pain or bleeding.

Instead of having an endoscope inserted, the person swallows a pill-sized capsule that contains a tiny video camera and light. Pictures are taken as the capsule travels through the GI tract, which usually takes about 8 hours or more. The camera sends the images to a small recording device worn around the person’s waist. The images from the recorder can then be downloaded onto a computer for the doctor to review. The capsule is passed with the person’s bowel movement.

Although capsule endoscopy is less invasive than an upper GI endoscopy, it has 2 main drawbacks:

  • A biopsy cannot be taken using capsule endoscopy.
  • It cannot be done if there may be an obstruction of the small intestine.

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Computed tomography (CT) scan

A 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. An abdominal CT scan is used to:

  • see what may be causing abdominal pain or a swollen abdomen (abdominal distension), such as a small intestine tumour
  • check if small intestine cancer has spread to nearby lymph nodes or tissues, such as the mesentery or peritoneum
  • check if small intestine cancer has spread to other organs, such as the liver

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During a biopsy, tissues or cells are removed from the body so they can be tested in a laboratory. The pathology report from the laboratory will confirm whether or not cancer cells are present in the sample. Biopsies that could be used for small intestine cancer are:

  • usually done during an endoscopy procedure (enteroscopy)
  • occasionally done when a laparotomy is performed

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Complete blood count

A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to check for anemiaanemiaA reduction in the number of healthy red blood cells. from long-term (chronic) bleeding from the small intestine.

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Blood chemistry tests

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can also be used to detect abnormalities. They are mainly used to stage small intestine cancer.

  • Increased alanine aminotransferase (ALT) and aspartate transaminase (AST) may indicate that small intestine cancer has spread to the liver.
  • Increased alkaline phosphatase may indicate that small intestine cancer has spread to the liver or bone.
  • Increased bilirubin (a chemical in bile) may indicate a problem with the liver or a blockage in the flow of bile because of a small intestine tumour. When the bile ducts are blocked, bile builds up in the liver, and jaundice develops due to the increased level of bilirubin in the blood.

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Tumour marker tests

Tumour markers are substances – usually proteins – in the blood that may indicate the presence of small intestine cancer. Tumour marker tests are used to check a person’s response to cancer treatment, but they can also be used to diagnose small intestine cancer.

The tumour marker that may be measured is carcinoembryonic antigen (CEA), which may be increased with adenocarcinoma of the small intestine.

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Laparotomy or laparoscopy

If a person has an obstruction, abdominal mass or ascites (a buildup of fluid in the abdomen) and doctors cannot make a diagnosis using other tests, they may sometimes do a laparotomylaparotomyA surgical cut to make an opening in the abdomen.. The doctor makes a cut (incision) in the person’s abdomen to look inside it for signs of cancer or disease. Samples of tissue are taken for biopsy. A laparotomy can also help stage a small intestine cancer.

Laparoscopy is a less invasive surgical procedure. The surgeon makes small cuts in the wall of the abdomen and inserts a laparoscopelaparoscopeA procedure that uses an endoscope (a thin, tube-like instrument with a light and lens) to examine or treat organs inside the abdomen and pelvis.. The doctors can examine the intestine and internal organs and take biopsies during laparoscopy.

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See a list of questions to ask your doctor about diagnostic tests.


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