Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Upper GI endoscopic or contrast radiographic evidence of duodenal tumor +++ Epidemiology +++ Adenocarcinoma + • 67% periampullary• Risk factors-Crohn disease-Ulcerative colitis-Polyposis syndromes-Villous adenomas-Hereditary nonpolyposis colon cancer +++ Lymphoma + • Risk factors-Malabsorptive and inflammatory diseases-Immunosuppression +++ Gastrointestinal Stromal Tumor (GIST) + • 10-30% are malignant• Difficult to distinguish benign from malignant on histologic studies +++ Symptoms and Signs + • Abdominal pain• GI or biliary obstruction• GI bleeding (hematochezia or melena)• Weight loss• Lymphoma: Fever, night sweats• Palpable abdominal mass +++ Laboratory Findings + • Anemia +++ Imaging Findings + •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 + • Symptoms should prompt upper GI contrast radiography or endoscopy and biopsy, which will be diagnostic +++ Rule Out + • Benign duodenal tumors + • Signs and symptoms of duodenal tumor• Upper GI endoscopy and biopsy will be diagnostic +++ When to Admit + • High grade obstruction• Acute upper GI bleeding• Severe abdominal pain• Obstructive jaundice + • Pancreaticoduodenectomy may be necessary for proximal duodenal malignancy +++ Surgery +++ Indications + • Resect all adenocarcinoma and GIST• Resect lymphoma if localized +++ Contraindications + • Disseminated lymphoma: Chemotherapy and radiation +++ Medications + • GIST: Imatinib mesylate +++ Treatment Monitoring + • Endoscopic surveillance after resection +++ Complications + • GI and biliary obstruction• GI bleeding +++ Prognosis + • After curative resections, the overall 5-year survival rate is 30%• Adenocarcinoma: 5-year survival stage I, 80%; Stage III, 10-15%. +++ 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. +++ Practice Guidelines + • The National Comprehensive Cancer Networkhttp://www.nccn.org/ Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth