Duodenal cancer

Classification according to ICD-10
C17.0	Duodenal cancer
ICD-10 online (WHO version 2019)

Adenocarcinoma of the duodenum

As a duodenal carcinoma is any malignant ( malignant ) tumors of the duodenum (duodenum).

Risk factors

Familial adenomatous polyposis ( obligate precancerosis ), Lynch syndrome , Crohn's disease , celiac disease , Peutz-Jeghers syndrome and Gardner syndrome are considered risk factors .

pathology

Macroscopic and microscopic pathology of duodenal carcinoma

Morphologically, the duodenal carcinoma usually grows polypoid. There are also scirrhous and sessile forms. Histologically, most cases are adenocarcinoma , followed by sarcomas , carcinoids, and lymphomas .

TNM classification of duodenal cancer

The TNM classification is used to characterize the tumor (so-called staging). TNM is an abbreviation for

T = tumor: extent of the primary tumor
N = Nodus: lymph nodes, absence or presence of regional lymph node metastases
M = metastases: absence or presence of distant metastases

TNM classification
T1	Infiltration of the lamina propria / submucosa
T2	Infiltration of the muscularis propria
T3	Infiltration of the subserosa / non-peritonealized perimuscular tissue ( mesentery or retroperitoneum ) up to 2 cm
T4	Non-peritonealized perimuscular tissue> 2 cm / neighboring organs / visceral peritoneum
N1	Regional lymph node metastases
M1	Distant metastases

Symptoms

In ulcerating tumors, anemia often occurs due to the loss of blood and the associated symptoms of decreased performance, fatigue and general weakness. Weight loss, postprandial pressure, vomiting and abdominal pain can also be observed. Tumors near the Vateri papilla often experience painless jaundice when the tumor compresses the papilla. In the late stages of the disease, the duodenum sometimes becomes completely closed ( ileus ).

Diagnosis

Diagnosis is carried out using sonography , gastroduodenoscopy with removal of a biopsy , enteroclysis , computed tomography or magnetic resonance tomography .

therapy

The therapy depends primarily on the exact location of the tumor and the stage of the disease. As a rule, a complete surgical resection (removal) of the affected section of the intestine and the removal of the associated lymphatic drainage area are sought. About 80% of carcinomas are resectable at the time of diagnosis. Usually a pylorus-conserving duodenopancreatectomy (so-called Whipple operation) is performed. In purely palliative operations , biliodigestive anastomoses are aimed for, e.g. B. by a choledochoduodenostomy or a hepatikojejunostomy . In some cases a stent is placed to maintain the passage of food. If the tumor proves to be inoperable, radiation therapy may be indicated in the event of tumor-related pain or significant blood loss . Furthermore, palliative chemotherapy , e.g. B. with fluorouracil to help relieve symptoms. The chemotherapy is based on the recommendations for the treatment of colorectal cancer .

forecast

The five-year overall survival rate is around 30%. The five-year survival rate is between 45% and 70% in patients in whom the tumor could be completely removed and who have no metastasis. If lymph node metastases are present, the value drops to 12–14%.

Web links

Small intestine carcinoma registration form (PDF; 1.6 MB), Association of German Tumor Centers , on the Heidelberg University Hospital homepage

Individual evidence

↑ ^a ^b ^c ^d Michael Gnant, Peter M. Schlag (Ed.): Chirurgische Onkologie ; Springer-Verlag, 2008; ISBN 978-3-211-48612-2 ; P. 259; here online at books.google, accessed on October 15, 2010.
↑ ^a ^b Wolfgang Remmele (Ed.): Pathologie 2 ; Springer-Verlag, revised edition 1996; ISBN 3-540-60119-8 ; P. 410; here online at books.google, accessed on October 15, 2010.
↑ Andreas Hirner, Kuno Weise: Chirurgie: Schnitt für Schnitt , Thieme Verlag, 2004, ISBN 3-13-130841-9 , p. 509; here online at books.google, accessed on October 15, 2010.
^ ^A ^b Wolfgang F. Caspary, Joachim Mössner, Jürgen Stein: Therapy of gastroenterological diseases ; Springer Verlag, 2005; ISBN 3-540-44174-3 , p. 205; here online at books.google, accessed on October 17, 2010.

[co-1] Michael Gnant, Peter M. Schlag (Ed.): Chirurgische Onkologie ; Springer-Verlag, 2008; ISBN 978-3-211-48612-2 ; P. 259; here online at books.google, accessed on October 15, 2010.

[path-2] Wolfgang Remmele (Ed.): Pathologie 2 ; Springer-Verlag, revised edition 1996; ISBN 3-540-60119-8 ; P. 410; here online at books.google, accessed on October 15, 2010.

[SfS-3] Andreas Hirner, Kuno Weise: Chirurgie: Schnitt für Schnitt , Thieme Verlag, 2004, ISBN 3-13-130841-9 , p. 509; here online at books.google, accessed on October 15, 2010.

[caspary-4] A ^b Wolfgang F. Caspary, Joachim Mössner, Jürgen Stein: Therapy of gastroenterological diseases ; Springer Verlag, 2005; ISBN 3-540-44174-3 , p. 205; here online at books.google, accessed on October 17, 2010.