Diagnosing Neuroendocrine Tumors of the GI Tract

Neuroendocrine tumors of the gastrointestinal tract are extremely rare. Finding them takes experience, skill and a first-rate team of topflight professionals. At Scott & White, we’ve assembled an internationally recognized multidisciplinary group of specialists and subspecialists working together to locate, identify and evaluate your neuroendocrine tumors of the GI tract.

Alongside your endocrine specialists — who provide you with information necessary for you to make informed decisions regarding your care — is a support team of nurses, technicians and other professionals ready to guide you through all stages of the diagnosis and treatment of your neuroendocrine tumors of the GI tract.

Neuroendocrine Tumors of the GI Tract Diagnostic Services

At Scott & White Healthcare, we use state-of-the-art diagnostic equipment to help identify and evaluate your tumors with clarity and precision.

If your physician suspects you may have a NET, he or she may recommend one or more of the following general tests.

View Diagnostic Services for Specific Neuroendocrine Tumors of the GI Tract

Physical Exams and Laboratory Tests

  • Physical examination and history. Your physician will begin with a thorough physical exam and medical history.
  • Blood and urine tests. Your physician may order one or more blood or urine test to check for abnormal levels of hormones or other substances.
    • Complete blood count. Checks the number of red blood cells, white blood cells and platelets; measures the amount of hemoglobin.
    • Serotonin.  Elevated levels in your blood may indicate a carcinoid tumor.
    • 5-HIAA. Elevated levels in your urine may indicate a carcinoid tumor.
    • Chromogranin-A (CgA). Elevated levels in your blood may indicate a carcinoid tumor or islet cell tumor (neuroendocrine tumor) of the pancreas.
    • 5-HTP. Elevated levels in your urine may indicate a carcinoid tumor.
    • Neuron-specific enolase (NSE). Elevated levels in your blood may indicate a carcinoid tumor.
    • Substance P. Elevated levels in your blood may indicate a carcinoid tumor.
    • Gastrin. Elevated levels in your blood may indicate a gastrinoma tumor of the pancreas or first portion of the small intestine (duodenum).
  • Immunohistochemistry study. This test is conducted in the laboratory on a tissue sample procured during biopsy. The pathologist will add an antibody, dye or radioisotope to the tumor sample to test for certain antigens (a substance that causes your body to have a specific immune response). With this test, your pathologist can determine which type of cancer you have.

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Endoscopy

Endoscopy is a procedure using a very small high-definition camera attached to a thin tube (endoscope) to examine the insides of your body. Your physician will remove small samples of tissue (biopsy) if he or she finds abnormal cells. Tissue samples are sent to the laboratory for evaluation by a pathologist.

You will be lightly sedated for all of the following endoscopic procedures.

  • Endoscopic ultrasound (EUS). In this procedure, your gastroenterologist will insert an endoscope with an ultrasound transducer on the tip:
    • Through your throat
    • Down your esophagus (the muscular tube connecting your throat to your stomach)
    • Into your duodenum (the first part of your small intestine)
      • Your physician will then take highly accurate pictures of your pancreas.
  • Upper endoscopy (esophogogastroduodenoscopy, or EGD). In this procedure, your gastroenterologist will insert an endoscope:
    • Through your throat
    • Down your esophagus
    • Into your duodenum 
      • With the endoscope, your physician will check for tumors in the upper part of your digestive tract.
  • Endoscopic retrograde cholangiopancreatography (ERCP). In this procedure, your gastroenterologist will insert an endoscope:
    • Through your throat
    • Down your esophagus
    • Into your duodenum
      • With the transducer, your physician can then view the ampulla of Vater (the connecting point for the common bile duct and the small intestine). Your physician will then inject a small amount of contrast dye through another thin tube (catheter) that is attached to the endoscope. The dye highlights your bile duct and pancreatic duct. A series of X-ray images will reveal any blockages or narrowing of the ducts.
  • Colonoscopy. In this procedure, your gastroenterologist will insert an endoscope through your anus into your colon. With the endoscope, your physician can check for neuroendocrine tumors in the lower part of your digestive tract, including your rectum and colon. You will be lightly sedated.
  • Proctoscopy/Sigmoidoscopy. In this procedure, your gastroenterologist will check for carcinoid tumors in your rectum, the 6 inches between the end of your large intestine and your anus. Your gastroenterologist will insert a short, hollow tube (proctoscope) through your anus into your rectum. With the proctoscope, your physician can view the lining of your rectum and anus.
  • Capsule endoscopy. In this noninvasive procedure, you will swallow a small camera in pill form. The camera will run through your digestive system, snapping pictures of the inside of your GI tract along the way. The tiny camera will take around 60,000 images, or two per second. You’ll wear a monitor to track its progress through your body. The images will be uploaded to a computer, where your diagnostic radiologist will read them, looking for neuroendocrine tumors in your digestive system.

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Imaging Tests

  • Abdominal ultrasound
  • Barium X-rays. Your physician may order a barium X-ray to check for the presence of carcinoid tumors in your GI tract.
    • Barium swallow/upper GI
    • Barium enema
    • Enteroclysis
  • Somatostatin receptor scintigraphy (OctreoScan). In this scan, radioactive octreotide (similar to your body’s somatostatin) is injected into your bloodstream; it attaches to the protein on the tumor cells of many NETs and carcinoid tumors. A gamma camera (a special radiation-detecting device) placed in front of your abdomen measures radiation. The octreotide will reveal the presence of carcinoid tumors and islet cell tumors of the pancreas.
  • Angiogram (arteriogram)

Your physician may order one or more of the following tests to determine whether your cancer has spread (metastasized) to other parts of your body.

  • Computed Tomography (CT) scan
  • Magnetic Resonance Imaging (MRI)
  • Positron Emission Tomography (PET) scan
  • Chest X-ray
  • Bone scan

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Biopsy

A biopsy is the best way to confirm the presence of neuroendocrine cancer. Your physician may recommend a biopsy of your pancreas or your gastrointestinal tract if cancer is suspected based on the results of other diagnostic tests.

With a biopsy, your physician will remove a small sample of tissue. The tissue sample will be sent to the laboratory for evaluation by a pathologist.

  • Fine Needle Aspiration (FNA). In this procedure, your interventional radiologist will insert a thin, hollow needle — precisely guided by CT scan or ultrasound — into your pancreas or GI tract to remove a small sample of tissue.
  • Laparoscopy. In this minimally invasive procedure, your surgeon will make a small incision in your abdomen and insert a very small high-definition camera attached to a thin tube (laparoscope). With the camera, your surgeon can see your tumor and whether it has spread to your adjacent lymph nodes. If cancerous masses are found, your surgeon will remove them with the laparoscope.

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