Diagnosing Small Intestine Cancer

NYU Langone doctors are experts at diagnosing small intestine cancer.

The small intestine is a tube-like organ that can be as much as 20 feet long. It is a part of the digestive system and helps break down food and absorb nutrients.

The small intestine has three sections. The duodenum is the first and shortest. It receives food that has been broken down in the stomach.

The middle section of the small intestine is called the jejunum. This is where most of the nutrients from food are absorbed.

The last section is the ileum. This is where the remaining absorption of nutrients occurs and where remaining contents pass into the large intestine, or colon.

Several types of cancer can arise in the small intestine. Adenocarcinoma is the most common. It develops from gland cells that line the intestine and secrete the fluid that aids digestion. Other types of small intestine cancer include carcinoids, which are a form of gastrointestinal neuroendocrine tumors, lymphoma, and sarcoma.

Crohn’s disease, which is chronic inflammation in the digestive tract, can lead to an increased risk of developing small intestine cancer.

People with certain hereditary genetic cancer syndromes are also at increased risk. These syndromes cause noncancerous growths called polyps to develop in the small intestine and other organs of the digestive tract. Polyps can eventually become cancerous. These hereditary syndromes include Lynch syndrome, familial adenomatous polyposis, which is also called FAP, and Peutz–Jeghers syndrome. NYU Langone specialists carefully monitor people with these genetic conditions for the development of small intestine tumors and other cancers of the digestive system.

Symptoms of small intestine cancer include abdominal pain, weight loss, nausea, vomiting, and gastrointestinal bleeding.

Tumors in the duodenum can sometimes grow large enough to block the common bile duct, a narrow tube that carries bile from the liver to the small intestine, where it aids in the breakdown and absorption of food. When this blockage occurs, bile backs up in the liver and enters the bloodstream. Eventually, this results in jaundice, which leads to symptoms such as yellowing of the skin and eyes, dark urine, light-colored stools, and itching.

After asking about your symptoms and taking a medical history, your doctor may perform one or more of several tests to diagnose small intestine cancer.

Upper Endoscopy

During an upper endoscopy, the doctor uses an endoscope, which is a thin, lighted tube with a camera at its tip, to closely look at the lining of the esophagus, stomach, and duodenum. The endoscope is placed through the mouth and slowly passed through the esophagus, stomach, and duodenum to look for tumors.

Doctors can pass small surgical tools through the endoscope to take tissue samples, which can help diagnose small intestine cancer. Upper endoscopy typically requires sedation, which helps relax you.

Capsule Endoscopy

Sometimes doctors use capsule endoscopy to detect tumors in the small intestine.

For this procedure, you swallow a small capsule with a tiny camera inside. As this capsule, which is about the size of a multivitamin, passes through the gastrointestinal tract, the camera takes thousands of pictures. These are transmitted via radio waves to a small receiver that you wear around your waist or place in a pocket.

It takes about eight hours for the capsule to pass through the gastrointestinal tract. It is excreted through a bowel movement and flushed down the toilet. Your doctor downloads the images from the receiver, paying special attention to those that are captured in the small intestine.

No sedation is required for capsule endoscopy.

Enteroscopy

If the capsule endoscopy detects a growth in the small intestine, doctors may perform an enteroscopy.

This procedure is similar to endoscopy, but it allows doctors to see deeper into the small intestine.

Doctors can take tissue samples from tumors using small tools placed through an endoscope. A pathologist—a doctor who studies diseases in a laboratory— examines this tissue for signs of cancer.

The procedure requires sedation or general anesthesia.

Endoscopic Retrograde Cholangiopancreatography

If a person has jaundice or if an endoscopy or enteroscopy shows that a tumor in the small intestine is near the common bile duct, doctors may perform an endoscopic retrograde cholangiopancreatography.

This type of imaging uses a special X-ray called fluoroscopy to create a picture of the bile duct. During the procedure, the doctor uses an endoscope to locate the bile duct and inject a dye called a contrast agent into the duct to enhance the images. If a tumor is identified, the doctor uses a small brush to collect cell samples from the ducts to examine under a microscope for signs of cancer.

If a duct is blocked by a tumor, the doctor may place a small plastic or metal tube called a stent into the duct. The stent opens the duct and allows bile to flow into the intestine, relieving the symptoms of jaundice.

Barium X-ray

Sometimes doctors use a barium X-ray, also called an upper GI series, to examine the upper digestive tract. During this procedure, you are asked to drink a dose of liquid barium, which temporarily coats the lining of the esophagus, the stomach, and the small intestine and is illuminated on X-rays.

The barium allows a radiologist to examine these structures as the liquid goes down, and can help him or her detect a tumor in the small intestine.

CT Scans and CT Enterography

NYU Langone doctors may order a CT scan, in which cross-sectional images of the body are created using X-rays and a computer. This test allows them to view the small intestine and other areas of the abdomen and pelvis to detect tumors and to determine whether cancer has spread to nearby organs or tissue, such as the lymph nodes. Lymph nodes are small immune system organs that trap foreign invaders such as viruses and bacteria. They are often the first place small intestine cancer can spread.

Doctors may also recommend an enhanced CT scan, known as a CT enterography. Before this scan, you drink a contrast agent that helps illuminate the small intestine and other organs in the abdomen and pelvis. As the liquid passes through the digestive tract, the CT scanner takes pictures of the small intestine, which can help reveal possible tumors that might be difficult to see on a standard CT scan.

MRI Scans and MR Enterography

An MRI scan uses a magnetic field and radio waves to create two- and three-dimensional images of structures inside the body. MRI scans are especially helpful when doctors need to visualize soft tissues, such as the lining of the intestines.

As with a CT scan, an MRI enables doctors to look at the small intestine and other parts of the abdomen and pelvis to detect growths and to see whether cancer has spread to nearby organs or tissues.

To get a better look at the gastrointestinal tract, the doctor may ask you to drink a contrast agent just before the MRI. This test, called MR enterography, can help reveal possible tumors that a standard MRI scan may not detect.