Duodenal Adenocarcinoma is a very uncommon disease, which does not show any previous history of its presence and occurrence. Therefore it is still a matter of discussion and the survival percentage of its patients and the ways to tackle this disease is still not exactly known.
The symptoms of Duodenal Adenocarcinoma disease many times confuse doctors. Thanks to the development of advance endoscopy and radiology that has helped in unearthing many of these type of cases. The only means by which potential cure can be achieved is through definitive surgery and the node-negative patients become much better with this prognosis. As it is told above it is an uncommon disease which presents itself in less than .4% among all gastro-intestinal tract tumors. Among these tumors about 45% occur from the duodenum’s third and fourth part.
When early diagnosis of colonic polyposis is done it has made the Duodenal Adenocarcinoma of the duodenum the main reason behind the death in patients of FAP. A continued 10 year study has revealed that the six patients among the 114 FAP patients died because of Duodenal Adenocarcinoma . The rate of incidence found to be higher in those types of patients who had more advanced duodenal polyposis at start of the study. The signs of this disease are not clear and specific. There can be signs like abdominal pains, weight loss, bleeding, jaundice or obstruction.
There is a different diagnosis for patients who show epigastric discomfort. The starting findings remain oesophago-gastroduodenoscopy and distinguished studies that can generally display the site, severity, and the lesion’s length. Proximal tumors can be found by oesophago gastro duo-denoscopy but the more distal tumors are generally found with the help of radiology-computed tomography, contrast studies and now PET.
In biopsy –confirmed cases there is a need of computed tomography for treatment planning and staging. When mucosal biopsy is taken while upper endoscopy a diagnostic dilemma comes up that shows inflammation. This can show the problem of peptic ulcer disease like bile duct and carcinoma of the Duodenal Adenocarcinoma or lesions such as gastro-intestinal stromal tumours or lymphomas.
Through endoscopic ultrasound measuring lesion’s thickness can be done which then will allow a more detailed biopsy of the lesion. Otherwise if there is no scope to pass then it can be good to opt for PET or computed tomography. If there is a presence of a greater volume of lesion then it shows the necessity for an operation. To get a final diagnosis intra-operative frozen section can be needed.
The only option for the tumor then remains of surgery only. The Whipple’s or radical pancreatic oduo-denectomy operation is an old type of operation but still it is being considered sometimes today also for the treatment of tumors which are in Duodenal Adenocarcinoma first and second part. In the third and fourth part many doctors are of the opinion to give duodenal segmentectomy treatment. But in both the whipple’s and duodenal segmentectomy treatment shows any difference in rate of survival of patients from the classical treatments.
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