Duodenal Cancer: Symptoms, Causes, Treatment, Risk

Duodenal cancer is a rare but fast-spreading cancer in your small intestine, or bowel. It’s also called duodenal adenocarcinoma.

The name comes from the word duodenum, the wide and short top part of the small intestine. This is where the contents of your stomach enter your lower digestive tract. Enzymes, bile, and stomach acid mix and mingle in the duodenum to break down your food before sending waste down to your colon and rectum.

Duodenal cancer is extremely uncommon. Almost all gastrointestinal cancers happen outside of the small bowel, such as in your colon, esophagus, stomach, and pancreas.

Causes and Risk Factors

Doctors aren’t sure exactly what leads to duodenal cancer, or why it’s so rare. They do know that like many cancers, it can start when genes turn faulty, or mutate, and allow cells to grow uncontrolled into a tumor.

Researchers believe that certain things may play a role in raising your chances of getting duodenal cancer.

Age. Most small intestine cancers are found in people in their 60s and 70s. That may be because it takes time for gene mutations to build up in your body.

Family. You might have inherited damaged genes or certain syndromes from your parents that put you at higher risk for this cancer. Health conditions include:

Diet. Eating a lot of red meat, sugar, and refined carbs like pasta and bread or too few vegetables and fruits may worsen your odds for small intestine cancer.

Smoking and alcohol. Not all studies agree that these pose a risk. But some research suggests that either alcohol or smoking or both may up your chances of small intestine cancer.

Duodenal growths. A benign, or non-cancerous, tumor in your duodenum may mean a higher chance of getting cancer there. The same may be true if you have small growths called polyps.

Intestine diseases. Other conditions that affect your intestines, such as Crohn’s disease, inflammatory bowel disease, and celiac disease, could contribute to a higher likelihood of small intestine cancer.

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Symptoms

Signs of duodenal cancer are often vague and easy to miss. You may not realize anything is wrong until the cancer has been growing for months. Symptoms may include:

As the cancer gets worse, other symptoms may include:

Anemia. This is when you have a low amount of red blood cells, which can make you feel fatigued or weak. It can happen if a tumor starts to bleed into the intestine.

Gastrointestinal obstruction. This happens when a tumor gets so big that it blocks anything from going through the intestine.

Jaundice. When a tumor in the duodenum blocks the bile duct, a bile pigment called bilirubin can build up and turn your skin and the whites of your eyes yellow.

Diagnosis and Survival Rates

Duodenal cancers are usually caught in later stages. That’s partly because the symptoms can be caused by many other conditions.

If duodenal cancer is caught early, before it starts to spread, 86% of people who have it live at least 5 years after the diagnosis, compared to their peers who don’t have cancer. But the 5-year relative survival rate falls by half, to 42%, if the cancer is found after it has spread far from the small intestine.

Diagnostic tests may include:

Imaging. This could be an esophagogastroduodenoscopy, a procedure where your doctor threads a tube with a light and a camera down your food pipe to the stomach and duodenum. An ultrasound can check if your lymph nodes have gotten bigger and how far a tumor has spread.

A type of X-ray called an upper gastrointestinal series can check for blockages and rule out other possible causes of your symptoms.

A computed tomography (CT) scan may not spot a tumor. But it can identify issues related to them, such as obstructions. It can also show you where cancer has spread.

Lab tests. Your doctor may take a tissue sample for a biopsy to confirm if you have cancer. Your doctor also may order a blood test since small intestine cancer can lead to anemia, or low red blood cells. You could also get a blood chemistry test to see how your organs are working. It’ll check to see if there are any abnormal levels of different substances in your body.

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Treatment

Surgery is usually the main way to treat duodenal cancer.

Resection. This means surgery to remove tissue, a structure, or organs. The most common option for a duodenal tumor is the Whipple procedure, which removes the head of the pancreas, the duodenum, the gallbladder, and the bile duct.

Lymph node removal. If the cancer has spread to your lymph nodes, removing them improves your chances of survival. Doctors don’t know exactly why that helps.

Surgery for symptom relief. You may get this if you have blockages in your bowel and are in pain.

Chemotherapy, a mainstay treatment for cancer, hasn’t been used often for duodenal cancer because it’s so rare. But research suggests that it may help if surgery isn’t an option.

What You Can Do

There are no proven ways to prevent this type of cancer. But you can take some steps to lower your possible risk.

Eat right. Load up on fresh fruits, vegetables, and whole grains. They’re packed with nutrients, vitamins, minerals, and antioxidants that can help lower your chances for cancer.

Exercise and keep a healthy weight. Being as lean as you can be may help prevent all kinds of cancers. Aim for 30 minutes of moderate exercise such as brisk walking every day.

Consider surgery. If you have an inherited condition that causes polyps, or growths, in your duodenum, removing that part of the small intestine may help ward off cancer.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on May 17, 2020

Sources

SOURCES:

American Cancer Society: “What Is a Small Intestine Cancer?” “Risk Factors for Small Intestine Cancer (Adenocarcinoma),” “Can Small Intestine Cancer (Adenocarcinoma) Be Prevented?” “Signs and Symptoms of Small Intestine Cancer (Adenocarcinoma),” “Tests for Small Intestine Cancer (Adenocarcinoma),” “Survival Rates for Small Intestine Cancer (Adenocarcinoma).”

Case Reports in Gastroenterology: “A Case of Inoperable Duodenal Cancer Achieving Long-Term Survival after Multidisciplinary Treatment.”

Cleveland Clinic: “Adult Jaundice.”

GI Cancers Alliance: “Gastrointestinal Cancers: An Urgent Need.”

Mayo Clinic: “Small bowel cancer,” “Cancer prevention: 7 tips to reduce your risk,” “Anemia,” “Whipple procedure.”

National Cancer Institute: “Blood chemistry test,” “Resection.”

U.S. National Library of Medicine: “Duodenum,” “EGD -- esophagogastroduodenoscopy.”

World Journal of Gastrointestinal Surgery: “Duodenal adenocarcinoma: Advances in diagnosis and surgical management.”

Brigham and Women’s Hospital: “The Digestive Process: What Does the Small Intestine Do?”

GI Cancers Alliance: “Gastrointestinal Cancers: An Urgent Need.”

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