Small Bowel Cancer

Diagnosis

To determine the best treatment options, physicians at Mayo Clinic use the latest diagnostic techniques to identify the type of tumor cells and the tumor's stage of development.

Medical History and Physical Examination

A first step toward diagnosing small bowel cancer is an in-depth interview with the patient. A physician gathers details about the patient's symptoms and when they first appeared.

After the physician has taken the patient's medical history, the next step is a physical examination. The physician will feel the abdomen for lumps, swelling, and areas where the patient reports pain. The physician may also order a blood test and ask the patient to provide a stool sample for testing.

Imaging Studies

High-resolution imaging studies help Mayo Clinic specialists diagnose small bowel cancer.

• X-rays generate a two-dimensional view of the chest and abdomen that helps physicians locate abnormalities in the small bowel and in other parts of the body where cancer may have spread.
• Ultrasound uses high-frequency sound waves to create images of the abdomen that can identify a tumor. A technician places a wandlike device (transducer) on the surface of the abdomen and monitors the image on a screen.
• Barium X-rays. Prior to having a barium X-ray, patients drink liquid containing barium, a radiopaque substance. With barium coating the intestines, X-ray images can show abnormal structures in the small bowel. Patients must abstain from food and beverages before the test.
• Endoscopic ultrasound (EUS) uses an endoscope (flexible tube) to pass an ultrasound probe into the gastrointestinal tract. A computer translates the sound waves sent around the small bowel into images that can identify tumors.
• Computed tomography (CT) scans generate two-dimensional images of the abdomen that may reveal whether cancer has invaded other tissues or organs. New technology at Mayo Clinic enables three-dimensional reconstruction of the CT images.
• Magnetic resonance imaging (MRI) uses magnetic fields and radio waves to create two- and three-dimensional used to identify small abnormalities in the soft tissue.
• Positron emission tomography (PET) scans use radioactive materials to identify metabolically active tissues, such as cancer, in the small bowel and other body organs.

Endoscopy or Colonoscopy

Specialists can examine the interior of the duodenum, the upper part of the jejunum (proximal jejunum), and the lowest parts of the small intestine (terminal ileum) using an endoscope or colonoscope. For these procedures, physicians give patients a mild sedative before passing a thin tube either down the throat and through the stomach (endoscopy), or up through the rectum (colonoscopy). A light inside the tube helps the doctor see abnormal areas in the small intestine. If necessary, a small sample of the cells can be taken for examination under a microscope by a pathologist, a procedure known as biopsy. Mayo Clinic physicians use two newer methods of endoscopic evaluation, wireless capsule endoscopy and double-balloon enteroscopy (DBE), which allow complete endoscopic examination (and in the case of DBE, biopsy) of the small bowel. Unfortunately neither test reaches the entire small bowel.

Biopsy

Before planning or recommending treatment, physicians at Mayo Clinic may wish to examine tissue from the small bowel in a laboratory. They often use fine-needle aspiration to gather a small sample of cells from the small intestine. Experienced pathologists examine the tissue under a microscope. In most cancer cases, pathologists classify the abnormal tissue as adenocarcinomas, carcinoid tumors, sarcomas, or lymphomas.