EUS Imaging

Cancers/Tumors

If you have been told that you have or might have cancer based on the results of tests such as standard sonogram/ultrasound, CT scan, MRI, endoscopy, ERCP, biopsy, blood tests, etc, confirming the diagnosis becomes the most important next step. Then, if it is cancer, determining the exact extent of the malignancy (staging) is essential to getting the best treatment. Sometimes a mass or tumor is found which may look like a cancer, but is not. Masses can sometimes be caused by inflammation that may clear up on its own.

Confirming that a mass is a cancer is important, and can usually be done with a special blood test or a biopsy. Sometimes, however, a suspected diagnosis of cancer cannot be confirmed or disproven. EUS can be very helpful in these situations because it can image and characterize the mass better than any other non-operative evaluation. Most non-operative imaging techniques can not accurately identify tumors smaller than 2 cm. EUS not only finds tumors less than 2 cm, but accurately stages these small tumors, which otherwise, maybe impossible without an operation. This accurate staging allows patients to get the most appropriate treatment.

Also, EUS can show if a mass is solid, and therefore if it can be safely biopsied. A biopsy specimen can be obtained more accurately with EUS because EUS allows pinpoint placement of a needle into the mass to obtain tissue or aspiration.

Lymphoma
When this type of neoplastic tumor occurs in the intestinal tract, it is usually found in the stomach. Recently, it has been discovered that many gastric lymphomas may be related to Helicobacter pylori infection, a bacterial infection related to many ulcers; these are called MALT lymphoma. They can often be cured with antibiotics, without surgery or chemotherapy. EUS most reliably shows how far a gastric lymphoma may have spread. Knowing the stage or extent of disease is very important to determine how closely the tumor must be monitored and whether other treatment is needed.

Stromal Cell Tumors (leiomyoma, sarcoma and other muscle wall tumors)
The entire intestinal tract has smooth muscle as part of the layers of the intestinal wall. Tumors can develop within these layers. Most of the time, these tumors are benign. Even when they are malignant, they are usually slow growing. Diagnosis and treatment has traditionally relied on clinical symptoms and surgery. However, with EUS-guided biopsies, tissue can be obtained and a reliable diagnosis made without an operation. Then, only those tumors that are malignant or have a significant risk of causing problems can be removed.