Small intestine cancer diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Biopsy is the gold standard test for the diagnosis of small intestine cancer.
Endoscopy and imaging tests can locate areas that have cancer, but the only way to confirm the diagnosis is to do a biopsy and histopathological analysis.
There are different ways to take biopsy samples of suspicious lesion.
There are numerous ways to take biopsy of small intestine:
- Endoscopy: Endoscopy can be used to biopsy the lesions of proximal duodenum to the ligament of Treitz or in the terminal ileum. Push enteroscopes can reach the proximal jejunum, but not distal jejunum and ileum.
- Laprotomy: is needed to biopsy a tumor in the intestines. This may be done if the tumor cannot be reached with an endoscope.

The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:

The [name of investigation] must be performed when:

The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
A positive [test] is detected in the patient, to confirm the diagnosis.

OR

The various investigations must be performed in the following order:

The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification to define small intestine cancer^[1]:


TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Tis	Carcinoma in situ
T1a	Tumor invades lamina propria
T1b	Tumor invades submucosa
T2	Tumor invades muscularis propria
T3	Tumor invades through the muscularis propria into the subserosa or into the non-peritonealized perimuscular tissue (mesentery or retroperitoneum) with extension ≤2 cm
T4	Tumor perforates the visceral peritoneum or directly invades other organs or structures (includes other loops of small intestine, mesentery, or retroperitoneum >2 cm, and abdominal wall by way of serosa; for duodenum only, invasion of pancreas or bile duct)