Small Bowel Cancer

Diagnosis

Diagnosis of small intestine cancer can be through the following techniques:

• Medical history and physical examination: The individuals undergo a comprehensive physical examination, which includes an abdominal examination for any swelling or lump to check the signs of small bowel cancer. Your doctor may also ask you about family history, symptoms, underlying medical conditions, and possible risk factors.
Blood tests: If there is a suspicion of small bowel cancer, the person is advised to undergo blood tests. These blood tests include complete blood cell count (to diagnose anemia) and liver function tests (to test if cancer spreads to the liver).
• Barium x-ray tests: This test involves the use of liquid containing barium. When the person drinks barium liquid, it flows through the gastrointestinal system and outlines the abnormal areas of the various organs of the GI system, such as the stomach, small intestine, and large intestine, that can be viewed through x-rays. Some of the types of barium x-ray tests include:
  Upper GI series: It involves performing the x-rays to check the abnormal areas of the upper GI system, such as the esophagus, stomach, and upper part of the small intestine. The oncologists may also view the problems in the remaining part of the small intestine by taking x-rays during the next few hours. It is known as small bowel follow-through.
  Enteroclysis: This test provides more detailed and clear images of the small intestine compared to the upper GI series and small bowel follow-through. The oncologist inserts a thin tube into the mouth of the individual and guides it to the small intestine. The barium liquid is sent directly into the small intestine through the tube. X-ray images are taken as the liquid moves into the small intestine.
  Lower GI series: This test determines if the small bowel cancer has spread to the rectum and colon. The bowel of the person is completely cleaned using enemas and laxatives before the process. A flexible tube is inserted into the anus, and barium solution is delivered to the large intestine. The air may also be injected through the tube to improve image clarity. This process is called air contrast.
• Magnetic resonance imaging (MRI): It provides detailed images of the intestine and allows oncologists to detect the presence of any abnormal tissues. In some cases, MR enteroclysis may be done to obtain better images of the intestine. A thin, long, and flexible tube is inserted into the mouth and is guided to the small intestine. A large volume of liquid contrast agent is then delivered into the intestine, which expands the intestine and provides improved-quality MRI images.
• Computed tomography: Computed tomography not only assists the oncologists in determining the small intestinal tumors but also helps determine the complications, such as obstruction or perforation, caused by the tumor. It also helps in detecting the extent of cancer metastasis. Computed tomography enteroclysis may help get a more detailed view of the small intestine. It involves delivering a large volume of liquid contrast agent through a tube and performing a CT scan. A CT scan also improves the precision of needle biopsy by guiding the needle accurately to the abnormal area (CT-guided biopsy).
• Upper endoscopy: It is also known as an esophagogastroduodenoscopy. The procedure is used to view the esophagus, stomach, and upper small intestine. The endoscope, a thin, long tube with a video camera at the end, is inserted through the mouth. The oncologists check for abnormal tissue as the tube passes through the GI system. If any abnormal tissue is found, tissue samples are obtained for further evaluation. This procedure is generally performed under the effect of sedatives.
• Capsule endoscopy: In this procedure, the individual swallows a capsule that has a small camera. As the capsule passes through the GI system, it sends several images to the device that is worn around the waist. These images can be downloaded on a computer and viewed by the cancer specialist as a video. The capsule is flushed out of the body through the usual peristaltic movement of the GI system.
• Double-balloon endoscopy: Upper endoscopy cannot provide a complete view of the small intestine due to the large size of the small intestine (almost 20 feet) and several curves. Double-balloon endoscopy is performed with a special endoscope comprising two tubes, one into the other. The procedure is performed under general anesthesia or sedation.
• Biopsy: Biopsy is the only procedure that confirms cancer. The sample of abnormal tissues can be obtained during endoscopy. There may also be bleeding in the small intestine after the endoscopic biopsy. It can be treated by injecting vasoconstriction drugs to stop bleeding. In some cases, there is a need for surgery to obtain the tissue samples if endoscopy fails to obtain the samples. A CT-guided biopsy may also be performed to obtain tissue samples from other organs, such as the liver (to detect cancer metastasis).