Duodenal Cancer – Symptoms, Causes, Diagnosis, Treatment and Risk Factors

Duodenal Cancer – Symptoms, Causes, Treatment, and Risk Factors: Duodenum is the upper part of the small intestine, its main function is to receive acidic food from the stomach and mix it with bile juice from the gallbladder and digestive juice from the pancreas. This is also responsible for the absorption of certain vitamins and minerals from the partly digested juices. It is further subdivided into superior, descending, horizontal and ascending parts.

Duodenal Cancer

Duodenal cancer starts in the glandular cells in the lining of the small intestine and is also known as duodenal adenocarcinoma. These glandular cells in the small intestine grow to form a tumour and block the intestine. It is a rare and speedy cancer, accounting for only 4% of cancer in America.  Duodenum cancer can be difficult to diagnose early on because its symptoms are similar to those of other gastrointestinal disorders.

For Reference:- https://en.wikipedia.org/wiki/Duodenal_cancer

Symptoms

The symptoms of duodenal cancer in its early stage are none and depict other gastrointestinal cancer, these symptoms may include the following –

1. Unexplained weight loss – patients may experience unexplained weight loss due to a loss of appetite and difficulty eating.
2. Abdominal pain – This is one of the most common symptoms of duodenum cancer. The pain is usually felt in the upper abdomen and can be severe.
3. Bloody stools – due to cancer in the part of the digestive system and the development of polyps in the rectum region, there will be blood in the stools.
4. Diarrhoea – it is the loose motions when your digestive system is not working properly, one tends to get diarrhoea.
5. A lump in the abdomen – due to the glandular cancerous cells, cysts can cause swelling in the lower abdomen, if cancer spreads to the inner lining of the small intestine, then there will be swelling due to ascites.  It bloats the stomach as well.
6. Nausea and Vomiting – patients may experience nausea and vomiting, which can be caused by cancer itself or by the blockage of the digestive tract.
7. Weakness and fatigue – due to indigestion, the patient may not be able to feed well which can cause weakness and fatigue. Along with this, the treatment of cancer can also be tiring and painful.
8. Anaemia – when a tumour starts to bleed, the level of RBCs and Haemoglobin reduces, causing anaemia.
9. Jaundice – Jaundice occurs when the liver is unable to process bilirubin, which leads to a yellowing of the skin and eyes.
10. Irritable bowel syndrome – Patients may experience changes in their bowel movements, such as diarrhoea or constipation.
11. Inflammatory bowel disease – due to the spreading of cancer, and the damage to healthy cells, the inflammation of the digestive tract increases, with prevailing symptoms like a stomach cramp, gas, diarrhoea, etc.

For Reference:- www.cancer.org

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Risk factors

The risk factor for developing duodenal cancer may include –

1. Age and sex – small intestine cancers usually develop during old age, especially after 60 – 70 years of age. And it is observed that men are more ted to get small intestine cancer than female.
2. Hereditary – cancer might also develop because of inherited genes that are cancer dominant linked or mutated to function for developing cancer and certain disorders. These might include cystic fibrosis, familial adenomatous polyposis (FAP), peutz-jeghers syndrome (PJS), MUTYH-associated polyposis, etc.
3. Gastrointestinal Disorders (GIDs) – the GIDs such as Crohn’s disease, celiac disease, inflammatory bowel disease, etc., are also the risk factor for developing duodenum cancer.
4. Colon cancer – this is also a risk factor for developing duodenum cancer as it can easily spread from the colon to the small intestine upper area.
5. Smoking – smoking cigarettes has shown a connection in the development of dysplasia and intestinal metaplasia, precursors for the lesions of gastric cancers.
6. Drinking –too much consumption of alcohol causes the degradation of the mucosal layer of the upper wide opening of the duodenum, therefore resulting in duodenal bleeding and soreness.
7. Diet – A diet high in red and processed meats, as well as low in fruits and vegetables, may increase the risk of developing duodenum cancer.

Diagnosis

1. Medical history and physical examination – the physical examination of the patient includes the signs and symptoms, bruises, lumps, or any unusual change. Along with this, the doctor will also require the medical history of the patient, including any suffered disease, ongoing treatment, any deadly disease running among the family members etc. this will help the doctor to better analyse the further test and the primary treatment to go with.
2. Blood test – in this a small amount of blood will be drawn from the patient’s body and will be examined for certain substances and their level in the body released by the respective organ. This will draw attention to any internal abnormal signs.
3. Imaging test – this might include esophagogastroduodenoscopy, in this procedure the doctor inserts a thin tube attached to a light and a camera from your mouth into your stomach and duodenum. Through this, they perform an ultrasound and check how big the tumour is and how far it has spread.  
4. Upper Endoscopy – in this the endoscope is inserted into the mouth to the stomach and duodenum. The camera attached to it finds the perfect position and then with the help of the attached needle, the sample is taken for examination under a microscope for cancerous cells.
5. Biopsy – this is the removal of the infected organ or part of the organ in order to examine it under a microscope. This can either be done through the surgical method, when a large portion of the organ is damaged, or via endoscopy or laparotomy.
6. Capsule Endoscopy – in this technique, the patient is made to swallow a large pill-size capsule, which is attached to tiny wireless cameras. This sends images to the device attached to the waist of the patient. The capsule is then passed out with the bowel movement.
7. Laparotomy – the cut is made into the abdomen walls, and then the sample is taken from the intestine for biopsy. Sometimes this is done to remove the infected organ therefore the incision depends upon the purpose of laparotomy.
8. MRI – in this procedure, magnets, radio waves along with a computer are used to draw internal images of the patient’s body.
9. CT-scan – a dye is injected into the veins of the patients, and then the X-ray machine is attached to the computer and is used to take images from inside of the body from different angles to form the 3-D image.

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Treatment

1. Whipple procedure – this procedure is also known as pancreaticoduodenectomy, which involves the surgical removal of the head part and duodenum part of the small intestine, along with the common bile duct, and parts of the stomach. After the removal of the following, the doctor stitches back leaving the intestine, bile duct and pancreas only.
2. Radiotherapy – this is done in two ways internal radiation therapy, involves a radioactive substance, packed in needles, seeds, wires or catheters and placed beside cancer.  The other way is external radiation therapy, which uses a radiation machine to send the radiation treatment to the cancer site from outside the body.
3. Chemotherapy –the treatment uses chemo drugs to stop cancer either by killing them or by slowing down their division rate. It is usually done along with other treatments. Such as after therapy to kill the remaining cancer cells or before the surgery to minimize the tumour.
4. Immunotherapy – this is also known as biological therapy, in this, the patient’s immune system is enhanced either from its body’s immune component or some components are injected into the patient’s body to function as an immune component to fight cancer.
5. Removal of lymph node – when cancer spreads to the lymph nodes, in order to increase the chance of survival, the doctors usually remove the lymph node to stop the further spread of cancer.
6. Surgery to relieve symptoms – sometimes, when the patients are suffering from acute symptoms, then instead of removing the tumour, the surgery is done to just relieve the symptoms such as blockage in the bowel and in severe pain.  

For Reference:- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4807322/

Prevention

There is no surefire way to prevent duodenum cancer, but there are certain lifestyle changes that can help reduce the risk. These include:

1. Maintaining a healthy diet – Eating a diet that is high in fruits and vegetables and low in red and processed meats may help reduce the risk of developing duodenum cancer.
2. Quitting smoking – Quitting smoking can reduce the risk of developing duodenum cancer, as well as other types of cancer.
3. Regular exercise – Regular exercise can help reduce the risk of developing cancer and other chronic diseases.
4. Regular screenings – People with a family history of gastrointestinal cancer should undergo regular screenings to detect any signs of cancer early on.

For Reference:- https://www.cancer.gov/types/stomach/patient/stomach-prevention-pdq

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