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  • • Upper GI endoscopic or contrast radiographic evidence of duodenal tumor

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Epidemiology

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Adenocarcinoma

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  • • 67% periampullary

    • Risk factors

    • -Crohn disease

      -Ulcerative colitis

      -Polyposis syndromes

      -Villous adenomas

      -Hereditary nonpolyposis colon cancer

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Lymphoma

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  • • Risk factors

    • -Malabsorptive and inflammatory diseases

      -Immunosuppression

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Gastrointestinal Stromal Tumor (GIST)

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  • • 10-30% are malignant

    • Difficult to distinguish benign from malignant on histologic studies

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Symptoms and Signs

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  • • Abdominal pain

    • GI or biliary obstruction

    • GI bleeding (hematochezia or melena)

    • Weight loss

    Lymphoma: Fever, night sweats

    • Palpable abdominal mass

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Laboratory Findings

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  • • Anemia

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Imaging Findings

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  • Barium x-ray studies: Duodenal tumors, particularly those in the third and fourth portions of the duodenum, may be missed

    Endoscopy and biopsy: Usually diagnostic

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  • • Symptoms should prompt upper GI contrast radiography or endoscopy and biopsy, which will be diagnostic

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Rule Out

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  • • Benign duodenal tumors

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  • • Signs and symptoms of duodenal tumor

    • Upper GI endoscopy and biopsy will be diagnostic

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When to Admit

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  • • High grade obstruction

    • Acute upper GI bleeding

    • Severe abdominal pain

    • Obstructive jaundice

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  • • Pancreaticoduodenectomy may be necessary for proximal duodenal malignancy

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Surgery

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Indications

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  • • Resect all adenocarcinoma and GIST

    • Resect lymphoma if localized

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Contraindications

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  • Disseminated lymphoma: Chemotherapy and radiation

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Medications

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  • GIST:Imatinib mesylate

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Treatment Monitoring

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  • • Endoscopic surveillance after resection

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Complications

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  • • GI and biliary obstruction

    • GI bleeding

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Prognosis

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  • • After curative resections, the overall 5-year survival rate is 30%

    Adenocarcinoma: 5-year survival stage I, 80%; Stage III, 10-15%.

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References

Bakaeen FG et al. What prognostic factors are important in duodenal adenocarcinoma? Arch Surg. 2000;135:635.  [PubMed: 10843358]
Isomoto H et al. Clinical and endoscopic features of adult T-cell leukemia/lymphoma with duodenal involvement. J Clin Gastroenterol. 2001;33:241.  [PubMed: 11500618]
Egberts JH. et al. Small bowel cancer: single-centre results over a period of 12 years. Hepato-Gastroenterology, 2007;54(73):129-34.  [PubMed: 17419246]
Oka K. et al. Aggressive carcinoid tumors arising in the duodenum, ileum, and rectum with liver metastasis: a report of three cases. Hepato-Gastroenterology, 2008;55(86-87):1660-3.

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Practice Guidelines

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