Through ongoing research, the medications used to treat cancer are constantly being evaluated in different combinations and to treat different cancers.If there is a reason to suspect you may have a GI neuroendocrine tumor/cancer, the doctor will use one or more methods to find out if the disease is present.

Medical History and Physical Exam

A medical history is an interview in which the doctor asks questions about symptoms and risk factors you may have. Some patients with neuroendocrine tumors/cancers also have cancers or benign tumors of other organs, so doctors may ask about symptoms that might suggest other tumors are present. A thorough physical exam will provide information about signs of neuroendocrine tumors/cancers and other health problems

Imaging Tests

Barium X-rays

These studies use a barium-containing solution that coats the lining of the esophagus, stomach, and intestines. The coating of barium helps find abnormalities of the lining of these organs. Barium studies can be used to examine the upper or lower parts of the digestive system.

A barium swallow (also known as an upper GI series) is used to examine the lining of the esophagus, stomach, and the first part of the small intestine. Patients getting this test drink a barium solution before the x-ray pictures are taken. A small bowel follow through is a continuation of this test that is sometimes used to look for problems in the small intestine. For this test, x-rays are taken at regular intervals over the course of a few hours as the barium passes through the intestines.

A barium enema with air contrast (also known as double-contrast barium enema or a lower GI series) is used to look at the inner surface of the large intestine

Barium x-rays are used less these days than in the past. In many cases they are being replaced by endoscopy — where the doctor actually looks into the colon or stomach with a narrow fiber optic scope.

Computed Tomography (CT)

The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these into an image of slices of the part of your body that is being studied. Often after the first set of pictures is taken you will get an intravenous injection of a contrast agent, or dye, which helps better outline structures in your body. A second set of pictures is then taken.

CT scans can help tell if your neuroendocrine tumor/cancer has spread into lymph nodes or other organs such as your liver.

You may need an IV line through which the contrast dye is injected. The injection can sometimes cause flushing. Some people are allergic and get hives.

Magnetic Resonance Imaging (MRI)

MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed by the body and then released in a pattern formed by the type of tissue and by certain diseases. An MRI can produce slices that are parallel with the length of your body. As with a CT scan, a contrast material might be used, but it is not needed as often.

MRI scans are a little more uncomfortable than CT scans. They take longer — often up to an hour. You have to be placed inside tube-like equipment, which is confining and can upset people with a fear of enclosed spaces. Newer, “open” MRI machines can help with this if needed. The MRI machine makes a buzzing noise that some people may find disturbing. Some places will provide headphones with music to block this sound.

Radionuclide Scans

Scans using small amounts of radioactivity and special cameras may be helpful in looking for carcinoid tumors. They can help determine the extent of the tumor, as well as help locate it if doctors aren’t sure where it is in the body.

Positron Emission Tomography (PET)

A PET scan is another imaging test that uses low levels of radioactivity to look for tumors. PET scanning for neuroendocrine tumors/cancers uses a radioactive form of 5-hydroxytryptophan, a chemical that is taken up and used by carcinoid cells. A special camera can detect the radioactivity

Endoscopy

These tests use a flexible lighted tube (endoscope) with a video camera on the end. The camera is connected to a monitor, which allows the doctor to clearly see any masses in the lining of the digestive organs. If abnormal areas are found, small pieces of tissue can be removed through the endoscope (biopsy). The tissue can be looked at under the microscope to find out if cancer is present and what kind of cancer it is.

Endoscopic Ultrasound

This is a fairly new technique used in some patients having endoscopy. For this test, the endoscope has a small ultrasound probe on the end. This probe releases sound waves and then detects the echoes that bounce off tissues of the digestive tract wall. A computer then translates the pattern of echoes into an image of the wall of the esophagus, stomach, intestine, or rectum. Endoscopic ultrasound is sometimes useful in determining how far a tumor has spread through the wall of the esophagus, stomach, intestine, or rectum. The test can also help predict whether the tumor has spread beyond the wall of these organs to nearby tissues or lymph nodes.

Biopsy

Even if an imaging test finds a mass, it cannot tell if the mass is a carcinoid tumor, some other type of tumor (benign or cancerous), or a localized infection. The only way to know for sure is to remove cells from the abnormal area and look at them under a microscope. This procedure is called a biopsy.

There are several ways to take a sample from a gastrointestinal tumor. One way is through the endoscope. When a tumor is found, the doctor can use a biopsy forceps (pincers or tongs) through the tube to take a small sample of it. Another way to sample a tumor is with a CT-guided needle biopsy, as was described in the section on CT scans.

Bleeding after a biopsy from a neuroendocrine tumor/cancer is a rare but potentially serious problem. If bleeding becomes a problem, doctors can sometimes inject drugs into the tumor that constrict blood vessels to stop the bleeding.

Blood and Urine Tests

Tests of the blood and urine can be very helpful in diagnosing carcinoid syndrome in patients who have symptoms that may be caused by it.

Other commonly used tests to look for carcinoids can include blood tests for chromogranin A (CgA), neuron-specific enolase (NSE), and substance P. Depending on the where the tumor might be located and on the patient’s symptoms, doctors may do other blood tests as well.