Small Bowel Cancer Diagnosis

At Winship Cancer Institute of Emory University, patients are cared for by a multidisciplinary team of gastrointestinal oncologists, surgeons, pathologists, radiologists and researchers who specialize in evaluating this disease. They rely on groundbreaking research, cutting-edge diagnostic protocols and experience in small bowel cancer to give patients the most accurate diagnosis possible.

Symptoms of small bowel cancer are often vague and non-specific — for example, abdominal pain — and because of the rarity of small bowel cancer, these symptoms often overlap with symptoms from other diseases. However, there are certain signs to look out for, especially in higher-risk individuals:

• Abdominal pain. May feel like cramping and may worsen after eating.
• Dark-colored stools. May indicate bleeding in the intestine.
• Nausea and vomiting. Can occur as the cancer progresses.
• Unintentional weight loss. Occurs as the cancer progresses.

Here at Winship, our specialized team sees a high volume of small bowel cancers, which helps us recognize concerning signs and accurately diagnose the disease. We know what to watch for when it comes to the signs of small bowel cancer — and more importantly, how to accurately diagnose it.

• Adenocarcinoma, which arises from glandular cells lining the small intestine. This is the most common type of small bowel cancer.
• Neuroendocrine tumors develop from the hormone-producing cells.
• Lymphoma starts in the immune system cells in the small intestine.
• Soft-tissue sarcomas are cancers that grow in the body’s connective tissues. In small bowel cancer, the sarcoma is a gastrointestinal stromal tumor, or GIST.

Patients with small bowel cancer but who have not yet been diagnosed might initially go to a primary care physician seeking relief from symptoms such as abdominal pain or bloody stools. This is the first step in diagnosing small bowel cancer.

From there, evaluation may include:

• Blood tests. These may include complete blood counts (CBC) to assess for anemia. Tumor markers are not routinely used for diagnosis but may be obtained in select cases. A doctor might also order a test to look for blood in the stool, which may be a sign of small bowel cancer.
• Imaging. Computed tomography (CT), magnetic resonance imaging (MRI) and, in some cases, specialized imaging such as CT enterography provide a detailed view of the small bowel and surrounding structures.

• Endoscopy. This specialized procedure provides high-resolution visuals of the small bowel using a tiny camera, allowing physicians to identify abnormal growths. Depending upon the need, this may involve an upper endoscopy, a capsule endoscopy where a patient swallows a camera-equipped pill, or a balloon-assisted enteroscopy that reaches deeper into the small bowel.
• Biopsy. During endoscopy, or sometimes surgery, tissue samples are collected to confirm the diagnosis and determine tumor type.