Duodenal Tumors, Malignant

• • 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

Practice Guidelines

• • The National Comprehensive Cancer Network

  • http://www.nccn.org/