What is Duodenal Cancer?

Duodenal cancer is a rare form of cancer in the duodenum, the first and shortest of three parts of the small intestine. The other two parts of the small intestine are the jejunum and the ileum. Shaped like a horseshoe, the duodenum sits between the stomach and the jejunum. Duodenal cancer often produces a duodenal tumor that, left untreated, can grow in mass over time and affect the duodenum.

The duodenum is essential to healthy digestion. The duodenum receives food from the stomach, breaks food down with bile and chemical secretions, and facilitates the absorption of essential nutrients into the body.

Duodenal cancer disrupts the digestive process and regular functioning of the duodenum. This disruption prevents needed nutrients from reaching the body.

Symptoms

Duodenal cancer symptoms often appear in the latter stages of the disease when a duodenal tumor grows large enough to block food from passing through the digestive tract. At this point, the body is unable to absorb essential nutrients.

There are several signs of duodenal cancer:

• Vomiting
• Nausea
• Constipation
• Acid reflux
• Weight loss
• Abdominal pain
• Abdominal mass
• Bloody stool
• Diarrhea
• Jaundice (yellowing of the skin and white portion of the eyes)
• Anemia (low count of red blood cells)

Many of these symptoms can also mean another digestive issue is present that is not cancer. Therefore, we recommend anyone with these symptoms to seek medical care to assess the signs, identify potential causes and receive appropriate treatment.

Causes

There is currently no consensus among medical professionals on duodenal cancer causes. However, there are known duodenal cancer risk factors. These risk factors fall into categories such as lifestyle, diet, genetics, age and preexisting conditions.

Recognized risk factors that may lead to or cause duodenal cancer:

• Lifestyle: Current research suggest that smoking and drinking can increase your risk for developing duodenal cancer, or any other cancer of the small intestines. More research is needed to confirm these findings.
• Diet: Studies suggest that diets high in red meat, salt, or smoked foods can increase your risk for duodenal cancer.
• Genetics: Inherited diseases such as cystic fibrosis and familial adenomatous polyposis, cancer of the large intestine, may increase the risk of developing duodenal cancer.
• Age: There are higher rates of duodenal cancer in older adults.
• Preexisting Conditions: Having gastrointestinal disorders, such as Crohn’s disease or celiac disease, or colon cancer can increase the risks for duodenal cancer.

Duodenal cancer is a rare, but potentially life-threatening disease. If you or a loved one experience any of these symptoms, please seek out the help of a caring and trained medical provider. Baptist Health is here to help.

Diagnosis

Duodenal cancer diagnosis is complicated by the physical shape and structure of the lower intestine (appears much like a folded tube), and by the delay of symptoms until the later stages of the disease. Duodenal cancer also shares the symptoms of several other conditions.

Diagnosis typically starts with a physical exam and patient interview regarding lifestyle, such as smoking and drinking, diet, family history of disease, and any pre-existing conditions.

Next, your doctor will recommend one or more of the following tests:

• Blood tests. Medical professionals take blood samples to check for signs of cancer and other potential conditions.

• Laparotomy: Your doctor will perform a surgical procedure by making an incision in the wall of the abdomen. This allows your doctor to check the inside of the abdomen for signs or symptoms of duodenal cancer.

• Endoscopy: Your doctor will use one of three different types of endoscopy to look inside your body for signs of duodenal cancer.
• Upper endoscopy. A doctor inserts an endoscope (thin tube) into a patient’s throat, through the stomach and into the duodenum. A light and camera built into the endoscope allows the doctor to view and photograph areas inside your body.
• Capsule endoscopy: A patient swallows a small pill-sized capsule with a built-in light and wireless camera. The capsule travels through the body, digestive tract and small intestines. During the journey, the tiny camera captures and sends images to a local recorder which, in turn, sends the images to a local computer for review.
• Double balloon endoscopy: Also known as double balloon enteroscopy, this procedure allows doctors to look inside of the small intestine using a medical instrument that involves two tubes, one inside the other, and a balloon. Doctors insert these tubes through the mouth or rectum. The interior tube is an endoscope with a light and camera. Methodically, doctors move the endoscope through each part of the small intestine to capture images. During this procedure, doctors periodically inflate a balloon attached to the end of the endoscope to hold the tubes in place for clear and accurate viewing and photographing. The balloon is then deflated to allow the endoscope to move through the body. The doctor may use a tool on the endoscope to remove any samples of abnormal tissue for further examination under a microscope. This is also known as a biopsy.
• Imaging tests. These tests capture images of the inside of your body so that doctors can check for tumors and other possible conditions. X-rays, Magnetic resonance imaging (MRI) and computerized tomography (CT) scans are common types of imaging tests. Doctors may ask patients undergoing imaging tests to drink a special dye that helps them more accurately identify cancers or other health issues.
• Biopsy. As part of an endoscopy test, a doctor may use the endoscope to remove a small sample of a possible duodenal tumor. The doctor examines the sample under a microscope to check for any signs of cancer.

Diagnosis for duodenal cancer occurs at one of the five stages (0-4).

Duodenal cancer prognosis depends on the stage of diagnosis, the presence and number of risk factors like age, diet, lifestyle, preexisting diseases, genetics, and the duodenal cancer metastasis, the possible spread to another part of the body. The outlook for duodenal cancer is improved if the cancer is detected and treated sooner rather than in the later, more aggressive stages of the disease. Research is ongoing to develop earlier methods of diagnosis and more effective treatments upon diagnosis.

Treatment

Duodenal cancer treatment depends on each patient’s individual characteristics, medical history, current health and risk factors. Treatment is also impacted by the stage of the disease at diagnosis.

Based on these factors, your doctor will likely recommend surgery, chemotherapy and/or radiation therapy. Sometimes surgery alone can treat the disease.

During duodenal cancer surgery, a doctor will remove any tumors from the duodenum. This allows food to pass through from the stomach to other parts of the small intestines. The doctor may also remove the duodenum, gallbladder, and part of the pancreas, a more intensive surgery known as the Whipple procedure.

Surgery can be combined with chemotherapy and radiation therapy (radiotherapy) to eliminate cancer cells.  However, these treatments often cause side effects such as hair loss, fatigue, weight loss, nausea and vomiting.

Nonsurgical treatment options:

• Radiotherapy. Doctors use a machine with focused, high-energy beams, such as X-rays, to kill cancer cells.
• Chemotherapy. A patient either ingests these medications orally or receives the medication by intravenous injection. Chemotherapy destroys cancer cells and/or prevents them from developing.
• Biologic therapy. This experimental treatment is new and may only be available through participation in a clinical trial. Doctors employ biological molecules to trigger a person’s immune system to attack the cancer.