Diagnosis & Staging
The small intestine is the largest part of your gastrointestinal (GI) tract.
The small intestine is about 2.5 cm (1 inch) across and about 4.5 to 6.0 m (15 – 20 feet) long. It has three parts:
- Duodenum: connects to your stomach.
- Jejunum: middle part.
- Ileum: connects to your large intestine.
- Pain or cramps in your abdomen (area below your ribs and above your pelvis). This is a common symptom.
- Nausea or vomiting.
- Weight loss you cannot explain.
- Lump in your abdomen.
- Blockage of your intestine.
- Anemia (not enough iron in your blood).
- Blood in your stool (poop) or dark stools (sometimes called melena).
- Diarrhea (loose or runny stools).
- Jaundice (when your skin or the whites of your eyes turn yellow).
Having one or more of these symptoms does not mean you have small bowel cancer. These symptoms can also happen because of other problems. For this reason, a person may not be diagnosed with small bowel cancer until the cancer is more advanced.
If you have any signs or symptoms that you are worried about, please talk to your family doctor or nurse practitioner.
Tests may help diagnose small bowel cancer include:
- Blood tests.
- Barium X-ray: used to look at the small intestine. You swallow a white, chalky liquid (barium mixed with water). After drinking the liquid, an x-ray technician takes x-rays of your small intestine. The barium is white on the x-ray image.
- CT (computed tomography) scan.
- Endoscopy: an endoscope is a flexible, lighted tube with a small video camera on the end. It is put into your body through your mouth. The endoscope then passes through your digestive system. A doctor will use the camera to look at your small intestine.
- Wireless capsule endoscopy: You swallow a small capsule that has a light and a very small camera. The capsule moves through your digestive system and takes thousands of pictures. The camera leaves your body during a bowel movement (going poop).
- Laparotomy: a cut is made into your abdomen so that a doctor can use a camera (laparoscope) to look at your organs.
more information on tests used to diagnose cancer: BC Cancer Library screening and diagnosis pathfinder.
- Adenocarcinoma: the most common type of small bowel cancer. It starts in the glandular cells in the lining of the small intestine.
- Carcinoid tumours: 30% (30 out of 100) of small bowel cancers are carcinoid tumours. They start in hormone-producing (endocrine) cells in the lining of the small intestine. These can be fast or slow growing cancers.
- Lymphoma: 14% (14 out of 100) of small bowel cancers are lymphomas. Most are non-Hodgkin's lymphomas.
- Sarcoma: 11% (11 out of 100) of small intestine cancers are sarcomas.
- Types of sarcomas
- liposarcomas start in the fat cells.
- angiosarcomas start in the blood vessels.
- neurofibrosarcomas start in the nerves.
- leiomyosarcomas start in the smooth muscles of the small intestine.
- Gastrointestinal Stromal Tumour (GIST): GISTs start in cells that are part of the autonomic nervous system in the wall of the small intestine. About 50 people are diagnosed with GIST in B.C. each year. It is very rare.
Staging describes the cancer. Staging is based on how much cancer is in the body, where it was first diagnosed, if the cancer has spread and where it has spread to.
The stage of the cancer can help your health care team plan your treatment. It can also tell them how your cancer might respond to treatment and the chance that your cancer may come back (recur).
- Stage 0: Tumour has not spread through the inner layers of your small intestine.
- Stage 1: Tumour has grown through the inner layers of your small intestine but has not spread into nearby tissue or lymph nodes.
- Stage 2: Tumour has spread through the entire wall of your small intestine but has not spread to the nearby lymph nodes.
- Stage 3: The cancer has spread to nearby lymph nodes but has not spread to other parts of your body.
- Stage 4: The cancer has spread to other parts of your body.
more information on staging: About Cancer
The grade of the cancer describes how different the cancer cells look from normal cells and how fast the cancer cells are growing. A pathologist will give the cancer a grade after looking at the cells under a microscope.
Small bowel cancer can be grade 1, 2, 3 or 4. The lower the number, the lower the grade.
Low grade: cells are abnormal but look a lot like normal cells. Low grade cancers usually grow slowly and are less likely to spread.
High grade: cells are abnormal and do not look like normal cells. High grade cancers usually grow more quickly and are more likely to spread.
The grade of the cancer can help your health care team plan your treatment.