Duodenal carcinoma is a very rare tumor of the gastrointestinal tract but is one of the most common arising from the small intestine. Tumors can develop in any duodenal segment, and the nonspecific clinical presentation of gastrointestinal complaints is the primary reason why it is often recognized late and why a poor prognosis is expected in many cases. Both invasive and noninvasive imaging studies are used to confirm the diagnosis.
Duodenal carcinoma (also known as duodenal adenocarcinoma, as the tumor arises from the glandular part of the epithelium) comprises less than 1% of all tumors from the gastrointestinal (GI) tract, but up to 55% of all small intestinal adenocarcinomas originate in the duodenum, suggesting its rather important place among neoplastic tumors of the GI tract     . Tumors may arise in any of the four duodenal segments - superior (I), descending (II), inferior (III) and ascending (IV), with respective variations in terms of frequency across different reports   . The clinical presentation of duodenal carcinoma is nonspecific, which supported by the fact that abdominal pain is the principal complaint   . Accompanying features are weakness, fatigue, GI bleeding and obstruction, weight loss, jaundice, nausea and vomiting  . Unfortunately, lack of clinical suspicion toward duodenal carcinoma as a result of nonspecific symptoms is the reason why the diagnosis is often made up to 15 months after the appearance of symptoms, leading to a poorer prognosis and inability to perform surgical resection of the tumor, thus requiring more aggressive forms of chemotherapy that are heavily tolerated  . Current understanding of the pathogenesis of this tumor is incomplete, but the presence of hereditary GI tract diseases, such as familial adenomatous polyposis and Gardner syndrome, as well as history of duodenal polyps, seem to increase the risk for duodenal carcinoma  .
Due to persistent abdominal pain and iron deficiency anemia the patient underwent push enteroscopy which revealed adenocarcinoma of the duodenum. [ncbi.nlm.nih.gov]
The clinical presentation of duodenal carcinoma is nonspecific, which supported by the fact that abdominal pain is the principal complaint. [symptoma.com]
There can be signs like abdominal pains, weight loss, bleeding, jaundice or obstruction. There is a different diagnosis for patients who show epigastric discomfort. [duodenal.org]
She was apparently alright until October 2014, and thereafter, she complained of abdominal pain and vomiting (3–4 episodes per day). [ccij-online.org]
Most of the clinical features are non-specific and include upper abdominal pain and weight loss as the most common presenting symptoms. [radiopaedia.org]
Characterize abdominal masses and adenopathy with the aid of diffusion-weighted MR imaging. [books.google.com]
Physical examination was unremarkable except for a vague ill-defined abdominal mass. [omicsonline.org]
At that point, you may notice an abdominal mass. Duodenal cancer can be classified into five major types: Diagnosing duodenal cancer can be difficult because symptoms occur in later stages of the disease. This can also make it difficult to treat. [healthline.com]
A palpable abdominal mass is found in less than 5% of the patients ( 5 ). Diagnosis Barium studies of the upper intestinal tract have been replaced by fiberoptic endoscopy. [ncbi.nlm.nih.gov]
Where the disease is advanced, the doctor’s examination may reveal: Abdominal mass/es; Enlarged lymph nodes (lymphadenopathy) Bowel obstruction; Fluid in the abdomen (ascites); Enlarged liver (hepatomegaly); and/or Lower extremity fluid accumulation [myvmc.com]
vomiting, constipation, (isolated stricture ileum) Ileum 5 cm proximal to ileo-caecal junction Histopathology of Rt.Hemicolectomy Synchronous metastases Right Hemicolectomy Recovery 8 Lee, 2011 50 IIa Epigastric pain 2 nd part duodenum Multiple biopsies [wjso.biomedcentral.com]
As mentioned previously, the nonspecific clinical presentation of duodenal carcinoma can be a significant challenge for the physician, but because early recognition dramatically improves overall survival, a meticulous workup should be carried out in all individuals with such complaints. The development of symptoms and their progression must be noted during history taking, and after a complete physical examination, imaging studies, considered as the cornerstone of diagnosis, need to be employed. Standard ultrasonography, computed tomography (CT) or magnetic resonance imaging (MRI) serve as first-line techniques   . To confirm duodenal carcinoma, esophagogastroduodenoscopy is the gold-standard in visualizing the tumor, but it is also beneficial because a biopsy sample can be obtained for histopathological examination during this procedure   . Upper endoscopic techniques may not always reach the site of the tumor, however, thus being unable to make the diagnosis unless specialized longer scopes are available . For this reason, barium radiography of the GI tract is also recommended, as it carries a very high rate of diagnosis as well  . A histological diagnosis is necessary, and together with CT/MRI findings, appropriate clinical staging of the tumor can be performed, which has critical implications for the choice of therapy.
Small Bowel Mass
View Article PubMed Google Scholar Ross A, Mehdizadeh S, Tokar J, Leighton JA, Kamal A, Chen A, Schembre D, Chen G, Binmoeller K, Kozarek R, et al: Double balloon enteroscopy detects small bowel mass lesions missed by capsule endoscopy. [biomedcentral.com]
This patient has multiple intraluminal small bowel masses (yellow arrows), which appeared to be metastases from an unknown primary. Also note the intussusception (red arrow) en soft tissue metastasis in the left gluteus muscle (blue arrow). [radiologyassistant.nl]
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