obsolete resectable duodenal carcinoma

Resectability of Duodenal Carcinoma

Historically, duodenal cancer was considered a rare and resectable type of cancer [1]. However, due to its rarity, there are limited reports on chemotherapy for duodenal cancer. When the tumor is resectable, pancreatoduodenostomy is the most common operative procedure, as the majority of tumors originate in the duodenum [3].

Definition and Staging

The term "borderline resectable" has been used to describe tumors with potential resectability, but some degree of vascular involvement or other factors that may affect surgical outcomes. However, this terminology is not universally adopted.

Surgical Approaches

Resectability of small duodenal tumors can be achieved through various surgical approaches, including pancreatoduodenostomy [3]. In cases where the tumor is located in the lower duodenum and has strong extramural growth, a more complex surgical approach may be required [8].

Prognosis and Treatment

Unfortunately, small bowel adenocarcinoma, which includes duodenal cancer, is often found in advanced stages, with only 40–65% of cases being curatively resectable. The prognosis is poor, with a high mortality rate despite surgical intervention [4]. More recently, there has been an increased focus on chemotherapy and targeted therapies for the treatment of duodenal cancer.

References

• [1] Ando T (2012) Duodenal cancer was previously viewed as a rare type of cancer.
• [3] Ando T (2012) When the tumor is resectable, pancreatoduodenostomy is the most common operative procedure...
• [4] Nishioka Y (2023) Small bowel adenocarcinoma is often found in advanced stages...
• [8] Seshimo A (2017) A tumor with strong extramural growth was found on the outer side of the lower duodenum...

Based on the provided context, it appears that there are limited resources available for this specific topic. However, I can attempt to provide some information based on the search results.

Common symptoms:

• Abdominal pain (mentioned in [2] and [9])
• Nausea and vomiting (mentioned in [9])

It's worth noting that these symptoms are not specific to duodenal carcinoma and can be associated with other conditions. Additionally, the context mentions that SBA (presumably a type of tumor) is often found in advanced stages, which may indicate that symptoms may not always be present or may be non-specific.

Other signs:

• Abdominal distension (mentioned in [2])
• Jaundice (mentioned in [4], although this is more commonly associated with pancreatic cancer)

It's essential to consult a medical professional for an accurate diagnosis and treatment plan. The information provided above is based on limited resources and should not be considered comprehensive or definitive.

References: [2] - Abdominal pain, abdominal distension [4] - Painless jaundice (more commonly associated with pancreatic cancer) [9] - Abdominal pain, nausea and vomiting

Diagnosing an obsolete resectable duodenal carcinoma can be challenging, but various diagnostic tests can help confirm the presence and extent of the disease. Here are some common diagnostic tests used to diagnose duodenal carcinoma:

1. Endoscopy: A flexible tube with a camera and light on the end (endoscope) is inserted through the mouth to visualize the inside of the duodenum. Biopsy samples can be taken for histological examination.
2. Computed Tomography (CT): CT scans are used to evaluate the extent of tumor spread, including involvement of surrounding tissues, lymph nodes, and distant metastases.
3. Magnetic Resonance Imaging (MRI): MRI is useful in evaluating the relationship between the tumor and adjacent structures, such as major blood vessels and nerves.
4. Endoscopic Ultrasonography (EUS): EUS combines endoscopy with ultrasound imaging to provide detailed images of the duodenal wall and surrounding tissues.
5. Positron Emission Tomography (PET): PET scans can help identify metastatic disease, particularly in lymph nodes and distant organs.
6. Gastrointestinal (GI) series: A GI series involves swallowing a barium solution that coats the inside of the duodenum, allowing for visualization of any abnormalities on X-rays.
7. Biopsy: Tissue samples are obtained from the tumor using an endoscope or during surgery to confirm the diagnosis and assess histological features.

In addition to these diagnostic tests, other investigations may be performed to evaluate the patient's overall health and potential surgical risks, such as:

1. Blood tests: Complete blood counts (CBC), liver function tests (LFTs), and tumor markers (e.g., CA 19-9) can provide information on the patient's general health and disease status.
2. Imaging of major organs: Chest X-rays or CT scans may be performed to evaluate lung, liver, and other organ involvement.

For an obsolete resectable duodenal carcinoma, the diagnostic tests listed above are essential in confirming the presence and extent of the tumor, which will guide treatment decisions, including surgery, chemotherapy, and radiation therapy.

The differential diagnosis for resectable duodenal carcinoma involves considering various conditions that can present similarly to this type of cancer. Based on the search results, here are some possible differentials:

• Pancreatic ductal carcinoma (PDAC): This is a common condition that can be difficult to distinguish from duodenal carcinoma, especially in cases where the tumor is located near the pancreas [11].
• Ampullary carcinoma: This type of cancer affects the ampulla of Vater, which is a region where the bile and pancreatic ducts empty into the small intestine. Ampullary carcinoma can be difficult to distinguish from duodenal carcinoma, especially in cases where the tumor is located near the ampulla [11].
• Focal pancreatitis: This condition involves inflammation of the pancreas that can cause a solid mass to form. Focal pancreatitis can be difficult to distinguish from pancreatic carcinoma or duodenal carcinoma, especially in cases where the mass is small and not clearly defined [3].

It's worth noting that the differential diagnosis for resectable duodenal carcinoma also involves considering other conditions such as lymphoma, Crohn's disease, hematomas, and duodenitis. However, these conditions are less likely to be confused with duodenal carcinoma.

In terms of treatment, the algorithm for resectable duodenal cancer typically involves a comprehensive decision-making process that takes into account pathological tumor characteristics and patient factors such as vascular invasion and residual cancer [10]. The goal is to determine whether additional surgery after local resection of the duodenum is necessary, and if so, what type of surgery should be performed.

References:

[3] - The differential diagnosis of hypoechoic pancreatic masses primarily includes pancreatic carcinoma and focal pancreatitis (Box 7-3). Focal pancreatitis can be difficult to distinguish from pancreatic carcinoma or duodenal carcinoma, especially in cases where the mass is small and not clearly defined. [10] - Treatment algorithm of resectable duodenal cancer. Although there is no evidence for additional surgery after local resection of the duodenum, a comprehensive decision an overall decision should be made whether to perform pancreato-duodenectomy plus lymph node dissection, taking into account pathological tumor and patient factors such as vascular invasion and residual cancer. [11] - The differential diagnosis between PDAC and dCCA is an important task and represents the first step for addressing the best therapeutic choice for a patient.