What is Duodenal Cancer?
Duodenal cancer is a malignancy in the duodenum, the initial part of the small intestine. This type of cancer is very rare and considered the rarest among the cancers in the gastrointestinal (GI) system, accounting for only 1% of the cases of GI malignancies.
Duodenal cancers take the form of adenocarcinoma, which constitutes 50% of the malignancies in the small intestines.
The duodenum is the area where food mixes with bile from the gall bladder and enzymes from the pancreas. The most common sites of malignancies in the duodenum include the periampullary and the ampullary portions of the duodenum.
Duodenal Cancer Location is at Duodenum Region
Signs and Symptoms
When the cancer cells grow, they block the passage of food from the stomach into the intestines, preventing food from being absorbed.
- Cramping pain on the abdomen
- Acid reflux
- Nausea and vomiting
- Mass in the abdomen
- Involuntary weight loss
- Blood in the stool because of chronic gastrointestinal bleeding
Almost all cases of duodenal cancer are diagnosed at a late stage because these symptoms usually appear only after the disease has been present for some time.
Causes and Risk Factors
- Exposure to carcinogens in the form of viruses, radiation and chemicals.
- Poor diets containing high amounts of fat.
- Gastrointestinal conditions including Celiac disease, familial adenomatous polyposis, juvenile polyposis syndrome, Lynche syndrome, Gardner syndrome, Crohn’s disease, and Puetz-Jeghers disease.
Stages of Duodenal Cancer
Stage 0- Carcinoma in situ
This involves the presence of cancer cells n the duodenal mucosa. It is a localized malignancy where the cells are contained only within the walls of the organ.
Stage I -Growth in the Duodenum
- Stage IA. Stage one involves the duodenum without serosal penetration and ascites.
- Stage IB. This stage involves the spread of the malignant cells in the subcutaneous fat and muscularis.
- Stage IC. This involves spread to the serosal area and the presence of ascites. Ascites are the accumulation of fluids in the peritoneal cavity as a result of an obstruction in circulation.
Stage II- Localized spread
The adjacent tissues, muscles, ligaments, fats and lymph nodes are now affected.
Stage III- Regional spread
Stage III of duodenal cancer involves spread to the adjacent organs such as the ileum, jejunum, colon, stomach and other abdominal structures.
- Stage IIIA. There are gross malignancies in the abdomen with microscopic seeding on abdominal structures.
- Stage IIIB. There are gross malignancies in the abdomen with less than 2 cm abdominal implants on abdominal structures. There inguinal or retroperitoneal nodes are not yet affected.
- Stage IIIC. There are gross malignancies in the abdomen with more than 2 cm abdominal implants on abdominal structures. The inguinal or retroperitoneal nodes are already affected.
Stage IV- Distant Metastases
There is widespread malignancy in the abdominal cavity with metastases to distant organs such as the lungs, liver, pancreas, bone and others. In this stage, the prognosis is usually poor because of extensive damage.
The diagnosis of duodenal cancer involves the following:
- Barium Swallow or Upper Gastrointestinal series. This procedure involves the ingestion of barium along with X-rays to determine any obstructions in the upper gastrointestinal tract.
- Imaging Tests. A CT-scan or MRI may be done to visualize the abdominal structures. Tumors are easily seen through these tests. An ultrasound may also be done, but is less definitive than theCT-scan and MRI.
- Endoscopy. This involves the insertion of a thin tube with a small camera from the mouth going to the duodenum. Endoscopy needs the administration of local anesthetics on the throat to eliminate the gag reflex. Through the endoscopy the physician is able to see the inside of the duodenum.
- Biopsy. A biopsy is the definitive diagnostic test to determine if a tumor is cancerous or benign. This test is not able to detect the stage of the malignancy. Surgery is usually done to remove the cancerous cells and to determine the stage of the disease, which will dictate any additional treatments.
Treatment for duodenal cancer is similar to other types of cancer and includes:
Resection is commonly employed for duodenal cancer, but tumors in this area are usually difficult to remove because of the huge blood vessel network present.
Another type of surgery that can be done is a Whipple procedure. This involves the removal of the duodenum, gall bladder, and the head of the pancreas. The resulting part of the small intestine is connected to the pylorus of the stomach and the bile duct and pancreatic duct are connected to the area below the pylorus.
Because a portion of the pancreas is removed, patients will be required take pancreatic enzymes.
Chemotherapy serves as an adjunct to surgery to completely eradicate the malignant cells. It is a systematic approach which reaches all areas in the body through the circulation. Chemotherapy is carefully administered to reduce side-effects and myelosuppression. Side-effects of chemotherapy include anorexia, hair loss (temporary), nausea and vomiting, fatigue, mouth sores, and increase in risk of infection.
Radiation therapy is sometimes employed although it may not be very beneficial for cancer of the small intestine. The mechanism involves exposure of the area to high-energy radiation to kill the cancer cells or shrink the tumor size. Radiation therapy can be administered internally or externally. Side-effects of radiation therapy include anorexia, fatigue, nausea or vomiting, bloating and gas pains.
Alternative medications that can be used to manage duodenal cancer include things such as garlic, ginseng, Echinacea and ginger. Studies in animals have proven that these herbal remedies reduce the size of tumors, but further tests must be made among humans before these findings are considered conclusive.
The prognosis of duodenal cancer depends on the progress of the malignancy. It is unfortunate, but duodenal cancer has a poorer prognosis than jejunum cancer or ileal cancer because tumors in the duodenum are usually much more difficult to remove.
According to studies, surgery has been the most effective way to manage intestinal cancers. Chemotherapy and radiation are less promising than surgical removal of the tumor. Older patients (above 75 years old) also have a poorer prognosis and lower survival rate than the younger population.
The survival rate for Duodenal Cancer decreases as the stage of the disease advances. Localized malignancies have almost 50% survival rate, regional malignancies have 30% survival rate, and distant metastases have 5% survival rate. It is indeed essential to detect cancer early and employ various types of management immediately in order to increase the survival rate.
Grammar check done by Andrea on 23/10/2012.
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