Duodenal cancer is a fairly common and severe disease. In this case, the cancer process affects the initial section of the small intestine - the duodenum. By symptoms, this disease can be difficult to distinguish from other cancerous lesions of the intestine. At the same time, people over the age of 50 suffer from this disease. In young people, this type of cancer is extremely rare.

Etiology

To date, the causes of oncological pathologies in the human body have not been fully studied - there are only certain hypotheses. In particular, many researchers suggest that the toxic effects of various food elements play a role in the development of such an ailment as duodenal cancer.

We can definitely say that this disease leads to:

• excessive addiction to alcohol;
• smoking in large quantities;
• food rich in animal fats;
• some diseases of the internal organs, such as, and polyposis.

Often, this disease is secondary, that is, it is a consequence of the germination of tumors from nearby organs.

Genetic predisposition to such an ailment as duodenal cancer plays one of the main roles in the etiological picture. In addition, during the research it was found that substances such as benzidine, nitrosamine and a number of others have carcinogenic properties and often cause the development of duodenal cancer.

Pathogenesis

Most often, duodenal cancer develops in the papillary region - this is the so-called peripapillary cancer. Suprapapillary cancer (upper parts of the organ) occupies only 16% in the clinic of this pathology. In addition, there is an infrapapillary type - the location of the tumor in the lower horizontal section.

It should be noted that this pathology, unlike many other types of cancer of the gastrointestinal tract, leads to the appearance of metastases much less frequently. This is an indicator of a very good chance for people with such a diagnosis to recover, because with cancer, either only the organ itself suffers, or both it and the lymph nodes surrounding it. But recovery is possible only if these are the first stages of the disease. In addition, there is a high probability that duodenal cancer itself is a consequence or, which can already metastasize.

Clinical picture

Depending on the type of tumor and its location in the organ, the clinical symptoms of the disease and methods of their treatment may vary. For example, with a tumor in the papillary region at an early stage, there are no symptoms, so the disease is often detected by chance during a routine examination or at later stages, when the symptoms are already obvious.

The first signs of this type of pathology are the difficult flow of bile into the intestine, which is manifested by pain in the hypochondrium on the right, constant nausea and loss of appetite.

At the stage of progression of the process, symptoms such as slight yellowing of the mucous membranes and skin can be noted, which intensifies over time. At the same time, due to disruption of the organ and the outflow of bile, patients usually develop.

• nausea;
• flatulence;
• pain syndrome in the right hypochondrium;
• heartburn;
• eructation of sour contents;
• heaviness in the stomach.

The progression of tumor growth leads to a gradual appearance - at this stage, a tumor-like formation in the intestine can already be palpated. With obstruction, patients may experience vomiting with bile impurities, and a feeling of squeezing in the right hypochondrium.

As with other oncological pathologies, duodenal cancer can cause general clinical symptoms. This, loss of appetite and a sharp decrease in weight, apathy and constant fatigue, decreased performance.

Pathological tumors of the duodenum can have a different structural structure, and according to this factor, tumors such as:

• neural type;
• reticulosarcoma;
• other.

Treatment of pathology

To date, the treatment of duodenal cancer involves the choice of one of three types of operations. At an early stage, and if the tumor is located in the upper horizontal zone, a circular resection is used, in which the affected area is replaced by an anastomosis. This operation is also suitable for intervention on the lower part of the organ, but the anatomical integrity is restored joint to joint.

The most difficult operations in the presence of a person with such a pathology as papillary duodenal cancer - in this case, the removal of not only part of this organ, but also others affected by the pathology is shown. To destroy possible pathological cells left after the operation, patients are prescribed a course of chemotherapy.

Many people are interested in the question of how long people live after removal of a duodenal tumor. Unfortunately, the prognosis of the disease is unfavorable, since the duodenum is connected to other organs, which are often also involved in the process. And since the disease is rarely detected at an early stage, and operations are performed already at the stage of progression of the pathology, only 5–8% of people manage to survive the five-year milestone after surgical removal of the affected area.

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Jaundice is a pathological process, the formation of which is affected by a high concentration of bilirubin in the blood. The disease can be diagnosed in both adults and children. Any disease can cause such a pathological condition, and they are all completely different.

It is no secret that microorganisms are involved in various processes in the body of each person, including the digestion of food. Dysbacteriosis is a disease in which the ratio and composition of the microorganisms inhabiting the intestines are disturbed. This can lead to serious disorders of the stomach and intestines.

Duodenal cancer (DUC) is a fairly rare disease, recorded in 0.3-2% of cases among all malignant tumors of the digestive system. In the vast majority of cases, duodenal cancer is diagnosed in people older than 50-55 years. According to statistics, pathology affects both men and women in equal numbers. The disease is characterized by a slow course and late symptomatic manifestations, which complicates timely diagnosis and increases the number of deaths.

Key predisposing factors of malignancy are smoking, excessive alcohol consumption, unhealthy diet, diseases of the gastrointestinal tract. Pathology is accompanied by dyspeptic disorders, bleeding, intestinal obstruction, weight loss. The main method of treatment is surgery.

If you or your loved ones need medical assistance, please contact us. The specialists of the site will advise the clinic where you can receive effective treatment:

What is duodenal cancer

The small intestine consists of 3 sections: ileum, duodenum and jejunum. More often, oncological lesions are localized in the duodenum - up to 50%. Pathological foci develop from the epithelial layer of the intestine, mainly in the area of ​​\u200b\u200bthe folds, in which residual enzymes produced by the gallbladder and pancreas are retained. In addition, the catalyst for neoplasia is exposure to carcinogens that enter the intestinal tract.

Primary malignancy is diagnosed less frequently than secondary neoplasia, which occurs against the background of the spread of oncological tumors of the pancreas, duodenal papilla, and bile duct. Benign tumors of the duodenum are not aggressive, so their spread in most cases is limited to regional lymph nodes and nearby organs.

Symptoms of duodenal cancer

The initial stages of neoplasia do not have specific symptoms. Primary complaints of patients may indicate a disease of the gastrointestinal tract, nausea, vomiting, heartburn, and periodic pain in the right hypochondrium occur.

As the oncological formation grows and spreads to part of the intestinal wall, the following manifestations of duodenal cancer are observed:

• Abdominal pain. May be aching or spasmodic. The intensity of the pain syndrome depends on the degree of tumor damage to the nerve canals. Pain is felt in the right hypochondrium or upper abdomen, usually worse after eating.
• Dyspeptic disorders. In addition to pain in the epigastric region, they include vomiting, nausea, heartburn, flatulence, and stool disorders.
• Weight loss. Weight loss causes non-perception of food, intoxication of the body, indigestion. As a result of anorexia, patients are worried about fatigue, decreased performance, and sleep disturbance.
• Jaundice. The catalyst for the symptom is bile stasis after the tumor has grown into the bile duct.

Pathological processes in duodenal cancer lead to intestinal obstruction, ascites, intestinal bleeding, peritonitis and intestinal ischemia. It is quite possible to prevent severe manifestations of oncological pathology with serious consequences if you immediately consult a doctor after the primary symptoms that resemble manifestations of diseases of the digestive system. Due to cutting-edge diagnostic methods, doctors will conduct a differential analysis of destructive processes and establish an accurate diagnosis.

Diagnosis of duodenal cancer

The examination of patients consists of several stages. First of all, patients undergo a physical examination. In the process, the doctor studies the anamnesis, takes into account individual factors, the patient's complaints. At the second stage, a number of laboratory tests are carried out, including a blood test, including for the presence of tumor markers, as well as an analysis of urine and feces for occult blood. Such studies make it possible to identify the type of a malignant tumor, assess the general condition of the body, the integrity of the intestine and the degree of spread of the malignancy process.

The next step is to conduct instrumental diagnostics. First of all, if duodenal cancer is suspected, doctors prescribe fibroesophagogastroduodenoscopy, a key method that allows you to identify a pathological formation, as well as make a biopsy for histological analysis of affected tissues and accurate verification of the diagnosis. An important role is played by fluoroscopy with contrast barium, in which all pathological obstructions in the intestine are visualized. For the most accurate assessment of the abdominal cavity, laparoscopy is sometimes used, in some cases with a biopsy.

Also in the course of instrumental diagnostics to determine the degree of spread of cancer to other organs include ultrasound, MRI, CT scan, bone scintigraphy, chest x-ray.

Causes of duodenal cancer development

The occurrence of atypical formations in the duodenum is multifactorial in nature. Experts identify several main predisposing causes of the development of the disease:

• genetic predisposition, family history of cancer, adenomatous polyposis;
• chronic precancerous conditions, including ulcerative colitis, polyposis, Crohn's disease, pancreatitis, etc.
• smoking, alcohol dependence;
• exposure to radiation;
• malnutrition, in which there is a large amount of animal fats, fried and spicy foods.

The accumulation of bile, which irritates the intestinal mucosa, increases the likelihood of developing a dangerous pathology of the duodenum. In addition, a high content of carcinogens that enter the gastrointestinal tract with food can become a catalyst for cell mutation.

Classification of duodenal cancer

According to the nature of the tumor growth, the following types of cancer are distinguished:

• endophytic, in which the neoplasm grows into the intestinal wall, which provokes tissue perforation, bleeding;
• exophytic, when a malignant tumor grows into the intestinal lumen, causing narrowing and subsequent intestinal obstruction.

According to the histological type, the disease is classified into mucosal adenocarcinoma, which occurs in most cases, as well as fibrosarcoma, neurinoma, sarcoma, and other types of neoplasia.

Stages of duodenal cancer

In accordance with the characteristics of neoplasia, it is divided into 4 stages of development:

Stage 1- a malignant formation of small size, localized in the submucosal layer of the duodenum.

Flock 2- the oncoprocess spreads into the muscular layer of the intestine, while the tissues of neighboring organs are not affected. In some cases, there are metastases in the lymph nodes.

Stage 3- neoplasia infiltrates beyond the intestinal wall, affects nearby organs at a distance of no more than 2 cm. There are numerous metastases.

Stage 4- carcinoma of any size with distant metastatic lesions of bones, kidneys, lungs and other organs.

Prevention of duodenal cancer

To minimize the risk of developing this disease, experts recommend adhering to preventive rules:

• timely cure diseases of the digestive tract;
• be regularly observed by a gastroenterologist in the presence of chronic pathologies of the gastrointestinal tract;
• eat properly and fully, include vegetable fats in the diet, as well as foods with fiber;
• give up alcohol, smoking.

Treatment of duodenal cancer

The oncology protocol depends on the diagnostic results. In accordance with the characteristics of the process of malignancy and the general condition of the patient, doctors use various methods of treating duodenal cancer. With a focus of a small size, low-traumatic, laparoscopic operations are prescribed using robotic medical equipment.

In most cases, surgical intervention is given - gastropancreatoduodenal resection, which involves excision of the affected part of the upper or lower intestine. In this case, the mesentery can be removed. Due to the optimal length of the intestine, it is possible to eliminate the tumor without affecting healthy tissues. To reconstruct the integrity, a gastroduodenal anastomosis is formed or the intestinal ends are sutured. Sometimes, according to the indications, excision of the duodenum is performed with the removal of the pancreas or part of the stomach.

In combination with surgical treatment, many cancer patients include chemotherapy in the protocol, the goals of which are to destroy residual cancer cells after surgery or reduce the size of the tumor before surgery, as well as to prevent recurrence. Radiation therapy is used to slow the growth of the lesion. As additional methods, oncologists can prescribe targeted therapy that prevents the growth of cancerous tissue and immunotherapy. In case of inoperable cancer, in order to alleviate the general condition, patients are shown symptomatic treatment, including the use of painkillers and sedatives.

Treatment of duodenal cancer with folk remedies

Infusions and decoctions of medicinal herbs effectively affect the body as a health remedy. However, after doctors issue a conclusion on the state of health with a diagnosis of duodenal cancer, one cannot rely on herbal medicine or other folk recipes.

Today, tens of thousands of Internet portals are promoting paying attention to the power of miraculous healing with the help of propolis, hemlock, mushrooms, celandine, etc. In fact, this information does not deserve attention, let alone trust. Using folk remedies against cancer is a dangerous waste of time, and in some cases even aggravating the problem. Therefore, oncologists strongly recommend not to self-medicate in extremely dubious ways. Only official medicine and a strong belief in healing will help get rid of a dangerous disease.

Today, foreign and Russian doctors are conducting unique programs for the treatment of duodenal cancer in oncology clinics in Moscow, where there are all the resources to increase the survival rate through successful treatment and diagnostic measures.

How long do people live after duodenal cancer treatment

Prediction is based on the staging of cancer and the morphological structure of the malignant formation. The most favorable prognosis is possible with localized pathological foci, when there are no regional and distant metastases.

Five-year survival rate is up to 90% of cases with stage 1 malignant formation, at stage 2 the rate does not exceed 75%. When an oncological lesion affects neighboring organs at stage 3, no more than 55% of patients live up to 5 years with adequate treatment. As a rule, in stage 4 duodenal cancer, the 5-year survival period is only 10-15%. A high mortality rate is due to a late visit to the oncology clinic due to the asymptomatic course of the disease, when the oncological process is in a neglected state. Therefore, at the first suspicious and uncomfortable manifestations associated with the gastrointestinal tract, you should immediately contact a gastroenterologist.

Treatment of duodenal cancer is a radical removal of the tumor or palliative intervention aimed at removing ...

Radiation therapy for duodenal cancer is performed to destroy the cells of a malignant neoplasm, ...

Oncology of the gastrointestinal tract is the third most common among all diseases. Duodenal cancer is a neoplasm that can affect the inner or outer wall of the organ. This disease is very difficult to detect at an early stage due to the erased symptoms. Most often, it is caused by a secondary lesion, which developed as a result of the ingress of cancer cells from neighboring organs.

There are two types of cancer:

1. Exophytic - affects the inner wall and grows into the intestinal lumen;
2. Endophytic - grows into the muscle layer and the serous (outer) membrane through and through.

Reasons for development

To date, the etiology of cancerous tumors has not been fully understood. Predisposing factors for the development of duodenal cancer include:

• smoking;
• alcohol consumption;
• improper and irregular nutrition (fatty, smoked food, etc.);
• the presence of malignant tumors of the gastrointestinal tract in relatives;
• a number of diseases of the intestines and nearby organs (ulcers of the duodenum and stomach, cholelithiasis, chronic pancreatitis).

The first signs and mature symptoms of duodenal cancer

In the early stages, duodenal cancer has virtually no symptoms. It can be detected only during a physical examination using ultrasound or FGDS (fibrogastroduodenoscopy).

The first signs of the disease appear when the tumor already has a decent size and interferes with the flow of bile and gastric contents into the small intestine. These include:

• nausea and heartburn, belching "sour";
• aching pain in the right hypochondrium;
• vomiting a few hours after eating, vomit may contain bile;
• , drastic weight loss.

All these symptoms are not specific, they can be observed in any other disease of the gastrointestinal tract. But they allow a person to suspect an ailment and consult a doctor in time for a complete examination.

In case of progression of the disease, the following are added:

• decrease in working capacity;
• blanching of the skin;
• anemia;
• temperature increase;
• white coating on the tongue;
• constipation and diarrhea;
• increased sweating.

In addition, the abdomen may visually enlarge due to the growth of the tumor. In severe advanced cases, black feces will appear due to the collapse of the neoplasm.

What is included in the diagnosis of duodenal cancer?

Diagnosis is carried out on the basis of anamnesis, patient complaints, examination, tests and instrumental methods of examination.

When examining the patient, you can see the pallor of the skin, plaque on the tongue, palpate the formation in the epigastrium or right hypochondrium.

Laboratory methods for detecting duodenal cancer include:

1. general and biochemical blood tests (indicators of anemia, increased liver enzymes due to stagnation of bile in the liver);
2. analysis of feces for occult blood (it will be positive when the tumor is healed);
3. (tumor markers will reveal the type of neoplasm).

Instrumental Methods:

1. EGD is the easiest way to see the tumor with your own eyes, assess its size, structure and take a biopsy.
2. Ultrasound - allows you to identify the endophytic form of cancer, to determine the presence of metastases in nearby organs.
3. CT and MRI are X-ray studies that allow you to examine the tumor in layers, as well as control the dynamics of the process.

Modern treatment of duodenal cancer

Treatment of this disease consists of surgery, targeted and chemotherapy.

Depending on the volume of the tumor and the presence of metastases, the operation can be either laparoscopic or laparotomic.

The first will be carried out in the early stages of the disease. The doctor makes a small incision and conducts the operation using microsurgical instruments and optical equipment. In this case, only tissues affected by the cancerous process are removed.

In the case of laparotomy, gastroduodenal resection is performed. A transverse incision is made and the duodenum is removed along with part of the stomach, nearby lymph nodes, mesentery and ligaments.

After the operation, the patient undergoes rehabilitation. Then he is prescribed for the prevention of metastasis.

Recently, they are also often used. The principle of its action is based on blocking the growth of cancer cells with the help of targeted protein molecules.

Survival

The five-year survival rate for this disease, detected at stages 1-2, is 70%. If pathology is detected at a later date and subject to gastroduodenal resection, the survival rate is 15-20%.

In each case, the prognosis will depend on the type of tumor, the process of metastasis, the presence of concomitant pathology, and the age of the patient. It is easier to diagnose duodenal cancer on time during routine examinations than to treat it at advanced stages, so be as attentive to your health as possible!

Duodenal cancer is a malignant lesion of the colon. Pathology is most often formed in the descending section (75% of cases), as well as in the upper and lower parts of the duodenum. The disease is rare, affecting patients of both sexes older than 55 years. At a young and young age, it is diagnosed in isolated cases. The primary process needs to be differentiated from tumors of the bile duct and duodenal papilla. More often, secondary duodenal cancer is detected, which is formed as a result of the germination of a malignant neoplasm from the stomach or other organs.

Symptoms and Causes

The early stages of the disease proceed without signs of manifestation of a gastric neoplasm. With the progression of the oncological process, symptoms of duodenal cancer appear:

• dizziness;
• nausea;
• general weakness;
• fast fatiguability;
• loss of appetite;
• fast weight loss;
• dry mucous membranes;
• change in skin color - cyanosis, pallor or yellowness;
• increased sweating;
• pain in the hypochondrium;
• feeling of heaviness in the abdomen;
• increase in body temperature.

Discomfort is aggravated after eating, in stressful situations, when drinking alcohol. To improve well-being, patients often take the “embryo” position to relieve pain.

With duodenal cancer, the following symptoms can also be observed: belching, heartburn, impaired stool and sleep. In the later stages, a neoplasm is palpated in the abdominal cavity, nausea becomes constant, vomiting with blood appears, and “tarry” black stools appear.

A significant role in the formation of duodenal cancer belongs to environmental factors: the environmental situation in the place of residence, working conditions, as well as the influence of ionizing radiation. Other provocateurs are:

• heredity;
• chronic diseases of the gastrointestinal tract;
• diabetes;
• eating habits (excessive consumption of convenience foods, coffee, marinades, canned food, fatty, fried foods);
• drinking alcohol and smoking.

Against the background of weakened immunity, the combination of several risk factors provokes a mutation of duodenal cells.

Classification

Cancer of the stomach and duodenum is characterized by metastasis. In the case of duodenal carcinoma, the lymph nodes in the area of ​​the head of the pancreas are predominantly affected.

According to the type of growth, a duodenal tumor is:

• endophytic - growing beyond the affected area;
• exophytic - growing in the intestinal lumen.

In most cases, adenocarcinoma is diagnosed, less often other types of cancer. The main forms of malignant tumors in duodenal cancer are:

• cancer of the major papilla;
• cancer from epithelial tissue;
• leiomyosarcoma;
• fibrosarcoma;
• neuroma;
• undifferentiated cancer;
• unclassified cancer;
• signet cell carcinoma;
• lymphosarcoma.

Duodenal cancer can be a stage of metastasis in cancer of the stomach, breast, uterus, lungs.

The disease has 4 stages of development, differing in signs, size of the tumor and the extent of metastasis:

• I - the neoplasm is small, clearly defined, located in the submucosal layer. There are no symptoms. No metastasis;
• II - tumor 2-5 cm in diameter, grows into the muscle layer. Metastases appear in the lymph nodes;
• III - a cancerous neoplasm more than 5 cm in volume, extends beyond the duodenum. Multiple metastases appear;
• IV - characterized by the collapse of the tumor, extensive metastasis.

In the initial stages, the cured disease has the best prognosis, but it is rarely diagnosed during this period. Late stages are detected in most patients who seek medical help with disturbing signs.

Diagnosis and treatment

A tumor of the duodenum begins to disturb with symptoms as the disease progresses. Diagnostic measures confirming a malignant pathology consist of laboratory and instrumental methods of examination, as well as a doctor's examination with palpation of the abdominal cavity.

Laboratory studies include analysis for oncomarkers, fecal occult blood, KLA, OAM.

Instrumental methods are of the greatest importance in establishing a diagnosis. The standard is esophagogastroduodenoscopy, during which, using a thin endoscope inserted through the mouth into the stomach, the doctor examines the internal organs of the abdominal cavity and, if necessary, performs a biopsy. Additional diagnostic options are also:

• contrast radiography;
• chest x-ray;
• sigmoidoscopy;
• irrigoscopy;
• Ultrasound of the abdominal organs.

Comprehensive diagnosis and examination of symptoms allows you to clarify the form, nature and stage of changes, plan further effective treatment.

If a malignant tumor is detected, the neoplasm is removed along with a part of the duodenum. Can be done in one of three ways:

• when the malignant process spreads to the major duodenal papilla and the excretory duct of the pancreas, gastropancreatoduodenal resection (GPDR) is performed - the affected intestine, the head of the pancreas, as well as the lower part of the bile and Wirsung ducts are cut out;
• with a small pathology, a circular resection is performed - removal of the damaged area with restoration of the patency of the intestinal section;
• a variant of circular resection is also used, when the intestine is connected end to end.

In the early stages of the malignant process, the removal of atypical cells is performed by laparoscopy.

Chemotherapy and radiotherapy may be given before surgery to reduce the size of the tumor, or after surgery to kill remaining cancer cells in the body.

The most dangerous complications of duodenal cancer are: stenosis, bleeding, tumor perforation. A serious problem is extensive metastasis in the later stages, cachexia.

Treating duodenal cancer with folk remedies helps block symptoms. The protective functions of the immune system are also significantly increased. It is used for a malignant process in the duodenum as an auxiliary method in the treatment.

Survival Predictions and Prevention

If duodenal cancer is diagnosed and treated in the first two stages, then the 5-year survival rate is about 70%. With a later detection of the tumor, the prognosis deteriorates to 15-20%. The histological type of neoplasm, age and general health of the patient are also important.

To reduce the likelihood of malignant changes in the duodenum, it is recommended: diet correction, avoidance of stressful situations, giving up bad habits, timely treatment of gastrointestinal diseases and annual preventive examination by a specialist after 50 years or earlier if there is a hereditary predisposition.

Duodenal cancer is a life-threatening and rare disease. Due to the predominantly late diagnosis, the prognosis is unfavorable. The success of treatment and survival depend on the stage of the disease. Duodenal cancer has nonspecific first symptoms, so the early stages of the disease are most often detected by chance, during examination for other gastrointestinal problems.

The duodenum is a rare malignant tumor (adenocarcinoma) that develops from the cells of the duodenal epithelium. Although the majority of cases occur in the duodenum (55.7%), duodenal adenocarcinoma (DA) ultimately accounts for less than 1% of all oncopathologies of the gastrointestinal tract. Overall, compared to some other periampullary malignancies, DA has a more favorable outcome. It is more likely to be curatively resected and has more favorable long-term results.

Causes and risk factors

Causal factors in the development of duodenal cancer have not been identified. There are two significant risk factors.

1. Duodenal polyps are significantly associated with a high risk of developing DA.
2. Hereditary factors such as familial adenomatous polyposis and Gardner's syndrome almost always lead to duodenal cancer.

Dietary factors such as increased consumption of bread, pasta, sugar, red meat, or reduced consumption of fruits and vegetables can be attributed to relative risk factors for small bowel adenocarcinoma, as well as. Alcohol intake, coffee and tobacco use are also risk factors for bowel cancer.

However, the significance of these associations is small, and most cases of AD are not associated with any known causes or risk factors.

Signs and symptoms

Duodenal cancer does not show symptoms until the tumor reaches a certain size.

And when the first signs of duodenal cancer appear, they are non-specific and include:

• abdominal pain;
• nausea;
• vomiting;
• fatigue;
• weakness;
• weight loss.

Anemia, gastrointestinal obstruction and jaundice join already in the advanced stages of the disease. Abdominal pain is the most common symptom associated with 56% of cases.

As a result, the disease is detected most often already in the later stages. It is very rare for patients undergoing screening programs to detect early DA or even a dysplastic adenoma before it becomes malignant.

Types of duodenal cancer

Histopathological subtypes of duodenal adenocarcinoma, depending on the type, may resemble cancer of neighboring organs.

stages

The currently accepted international staging system (8th edition) for duodenal carcinoma emphasizes the importance of tumor invasion of the pancreas and metastases to the lymph nodes. Size has little effect on the clinical stage of the tumor.

Primary tumor 12 of the duodenum is defined as follows:

• TX - Primary tumor cannot be assessed;
• T0 - no signs of a primary tumor;
• Tis - Carcinoma in situ;
• T1a - the tumor is limited to the epithelial layer;
• T1b - the tumor penetrates the submucosa;
• T2 - the tumor penetrates into the muscular layer of the duodenum;
• T3a - the tumor perforates the visceral peritoneum, or penetrates the pancreas (up to 0.5 cm);
• T3b Tumor invades more than 0.5 cm into the pancreas or extends to peripancreatic tissue without involvement of the superior mesenteric artery
• T4 Tumor involves superior mesenteric artery and/or common hepatic artery, regardless of size

Regional lymph nodes are defined as follows:

• NX - regional lymph nodes cannot be assessed;
• N0 - absence of regional metastases in the lymph nodes;
• N1 - metastasis to one to three regional lymph nodes;
• N2 - metastasis to four or more regional lymph nodes.

Distant metastases are defined as follows:

• MX - the presence of distant metastases cannot be assessed;
• M0 - no distant metastases;
• M1 - distant metastases.

Clinical stages of duodenal cancer according to the TNM system

Diagnostics

Endoscopy remains the diagnostic method of choice today. Evaluation by an experienced endoscopist is of primary importance as it allows both imaging and biopsy to be performed simultaneously. Particular attention should be paid to the condition of the relevant structures, such as the papilla of Vater.

Lesions in the third or fourth part of the duodenum can be technically difficult to view endoscopically. Therefore, now in clinics in Belgium, the use of modern endoscopes with an elongated thin tip, which has increased flexibility, is in use. Such devices make it possible to examine the entire duodenum.

Lesions in the distal duodenum may be missed in the initial endoscopic evaluation if outdated equipment is used or if the endoscopist is not qualified. This leads to further diagnostic delays.

Endoscopic ultrasonography may be performed concurrently with direct imaging to evaluate local enlargement or lymphadenopathy. In addition, it may facilitate diagnosis if attempts at transluminal biopsy have failed.

Computed tomography with contrast is important for assessing damage to adjacent structures, determining resectability (possibility of removal), and planning surgery. However, MRI is able to provide more information to the doctor at the initial stages of diagnosis, and therefore its appointment is a priority.

Treatment

Surgical approach

Tumors located in the second part of the duodenum usually require pancreaticduodenectomy (Whipple operation) due to proximity to the head of the pancreas, distal bile duct, and papilla of Vater.

Conversely, tumors originating in the first, third, or fourth part of the duodenum can be treated with both Whipple's surgery and segmental resection ( with preservation of the pancreas ).

In US oncology practice, it is considered that pancreaticduodenectomy should be used for all DAs, regardless of their position, to provide wide margins and adequate regional lymphadenectomy (removal of lymph nodes).

This opinion is based on the results of an early series of reports on several groups of long-term survivors.

Most of the European studies that compared the results of the two approaches did not reveal statistically significant differences in the results. But they were limited by small sample sizes.

In a Cochrane Center study of 1611 patients from 1988 to 2010, radical pancreatic duodenectomy was not associated with improved overall survival.

In Belgium, oncologists take a European view - although pancreaticduodenectomy may be required for technical reasons in some situations, pancreas-sparing segmental resection would be an appropriate strategy if complete removal of the primary tumor can be achieved.

Palliative Surgery

Among patients with localized DA, approximately 43-67% have resectable duodenal cancer. The remaining patients require palliative care to maintain an acceptable quality of life.

The goals of palliative surgery for AD include:

• elimination of obstruction at the outlet of the stomach;
• relief of obstruction of the biliary tract;
• pain relief.

Surgical interventions for gastroduodenal obstruction may include gastrojejunostomy or duodenojejunostomy.

In Belgian clinics, these operations are usually performed according to the Roux-en-Y principle using a minimally invasive laparoscopic approach.

Surgery for biliary obstruction usually involves endoscopic stenting of the ducts. And only if it is impossible to perform an endoscopic operation with a high degree of biliary obstruction, it is recommended to perform the operation through a laparoscopic access.

This recommendation is justified by the fact that blockage of the bile ducts occurs, as a rule, in the final stages of the disease. The prognosis is very limited, and doctors try to avoid unnecessary trauma to the patient.

Chemotherapy

Duodenal adenocarcinoma is a rare disease. Therefore, at present, there is little data to determine the correct strategy for adjuvant chemotherapy after complete surgical resection.

Given the rarity of the disease, in most therapeutic studies, DA has traditionally been associated with either other periampullary cancers or adenocarcinomas of other parts of the small intestine. For this reason, chemotherapeutic regimens are not standardized, but more and more AD is being treated similarly to colorectal adenocarcinoma with oxaliplatin-based chemotherapy. Given the propensity of this disease for systemic recurrence, the role of adjuvant chemotherapy requires further study.

The current practice in Belgian cancer centers is to treat patients with high-risk signs (eg, nodular metastases) with oxaliplatin-based chemotherapy.

The multicentre, randomized, controlled, phase III ESPAC-3 trial compared conservative surveillance with adjuvant therapy with fluorouracil and adjuvant therapy with gemcitabine in patients with duodenal cancer.

All patients underwent pancreaticduodenectomy. Although median survival did not differ significantly between the observation and adjuvant groups in the primary analysis (35 mo. against 43 months), adjuvant chemotherapy was associated with an improvement in the overall subjective symptoms of the disease.

Definitive or palliative chemotherapy should be offered to all eligible patients with metastatic or inoperable disease.

A prospective phase II study studied 30 patients with metastatic or unresectable ampullary adenocarcinoma treated with capecitabine and oxaliplatin. As a result, 50% of partial responses and 10% of complete responses were reported. The median time to progression was 11 months with a median overall survival of 20 months. Patients should also be considered for clinical trials if needed.

Chemoradiation complex therapy

The role of adjuvant radiotherapy in the treatment of AD is not well defined. No study has demonstrated a positive effect on the tumor with the use of radiation therapy.

With regard to the integrated approach, the situation looks more optimistic.

A study of 14 Johns Hopkins patients with a positive DA node who underwent pancreatic duodenectomy and received adjuvant chemoradiotherapy (average dose of 50 Gy, concomitantly with 5-FU) resulted in improved local control compared to surgery alone (93% against 67%).

Similarly, a retrospective study of 32 patients at Duke University Medical Center showed a modest improvement in local control (70% against 49%) with adjuvant chemoradiotherapy.

But, unfortunately, none of the studies showed that adjuvant chemoradiotherapy contributed to a significant improvement in overall survival. The 5-year survival was 44% vs. 43% in the first study and 44% vs. 57% in the second, respectively.

Other retrospective series have shown similar results with improvements in regional control but not overall survival.

However, this approach, which aims to improve local space control, may make chemoradiotherapy particularly useful in patients with lymph node metastases.

In a study of 122 patients with duodenal cancer who underwent therapeutic resection, interesting results were obtained. Adjuvant chemoradiotherapy in patients with a higher prevalence of regional lymph node metastases resulted in the same overall survival rate as in the group of patients with limited or no nodal metastases who did not receive adjuvant therapy.

Survival prognosis

DA is an aggressive cancer, but patients with resectable disease have better long-term outcomes than other periampullary malignancies.

In a retrospective study of 122 patients who underwent PD for DA for 22 years at MSKCC, the 10-year overall survival was 41%.

In a prospective cohort study of 150 patients in six cancer centers in Europe who had in 2000-2013. duodenal cancer 12, survival rate was:

• 1 year - 83.9%;
• 3 years -66.7%;
• 5 years - 51.2%.

The median disease-free survival in this study was 53 months.

Another recent study conducted at several cancer centers in the United States showed that in patients diagnosed with duodenal cancer, the prognosis largely depends on the stage of the disease at the time of diagnosis. The resulting five-year survival was:

• stage 1 - 65.9%;
• stage 2 - 50.4%;
• stage 3 - 31.4%;
• Stage 4 - 11.9%.

Patients with metastatic or inoperable disease have a median survival of 2 to 8 months.

Prevention

The reasons for the development of duodenal cancer have not been established. Therefore, there are no specific preventive measures. However, there are some principles based on which you can reduce the risk of developing the disease.

Conducting periodic gastroduodenoscopy (1 time in 2-3 years) will allow timely detection of the presence of polyps and taking appropriate measures even before they degenerate into a malignant tumor.

At the polyp stage, it is enough to remove the polyp itself, and if atypical cells are not found in the pedicle area, endoscopic screening can be performed at the same frequency.

It is also worth following the usual cancer prevention measures, such as quitting smoking, reducing the use of hard liquor, limiting red and processed meat in the diet, etc.

Find out more about duodenal cancer treatment options in Belgium. Write to us or request a call back. We will provide comprehensive answers to your questions.