Treatment of Duodenal Cancer

Duodenal cancer is a rare oncological disease of the first part of the intestine. The basis of its treatment is surgery. If the neoplasm is completely removed, then the ten-year survival rate of patients exceeds 40%, which in most cases means a complete cure for the disease in these people. Other treatment methods such as radiation therapy and chemotherapy are less common.They are usually used in the advanced stages of the disease. You can undergo treatment for duodenal cancer abroad with good results and minimal health risks.

Content

1. What is duodenal cancer?
2. Diagnostics
3. Surgical treatment
4. Chemotherapy
5. Radiation therapy
6. Why is it worth undergoing treatment abroad?
7. Treatment for intestinal cancer in Europe with Booking Health

What is duodenal cancer?

The duodenum is the "crossroads" of the gastrointestinal tract. It is located between the pylorus (lower part of the stomach) and the jejunum. The pancreatic and bile ducts open into the duodenum. Cancer of this organ accounts for less than 1% of all malignant neoplasms of the digestive tract and 55% of neoplasms of the small intestine.

Tumors can develop in different segments. The type of surgery performed depends on where the neoplasm is located. The organ consists of four parts:

• The first segment of the duodenum is suspended on the hepatoduodenal ligament, lies on the peritoneum, begins immediately behind the stomach, and has a length of about 5 cm. The first segment continues to the flexure of the duodenum.
• The second segment is located behind the peritoneum. It has a length of 7.5 cm, is fixed to the head of the pancreas, and goes around it.
• The transverse part of the duodenum or third segment is 10 cm long. It lies anterior to the aorta and inferior vena cava, but behind the superior mesenteric vein and artery.
• The ascending part of the duodenum or the fourth segment is 2.5 cm long. It goes up and laterally (outwards). In this segment, the intestine reenters the peritoneal cavity after reaching the ligament of Treitz, at the anatomical border of the transition of the duodenum into the jejunum.

Controlled risk factors for the disease include smoking, alcohol, excess red meat in the diet, and celiac disease.

Other risk factors include male sex, age 60-70 years, and Crohn's disease. Many cases are associated with hereditary syndromes that also cause other health problems and increase the risk of other cancers. These include cystic fibrosis, Lynch syndrome, Peutz-Jeghers syndrome, and MUTYH-associated polyposis.

Five-year survival rate by stages: 

• Stage 1 – 66%;
• Stage 2 – 50%;
• Stage 3 – 31%;
• Stage 4 – 12%.

Diagnostics

Early diagnosis of duodenal cancer is unlikely. Typically, patients see a doctor only after the tumor is large enough to cause symptoms. Clinical signs are nonspecific, and the disease is rare, so not all doctors can immediately make a diagnosis. Many patients undergo treatment under other diagnoses for some time before the tumor is detected.

The main symptoms are as follows: 

• abdominal pain;
• nausea;
• vomit;
• jaundice.

Esophagogastroduodenoscopy is the main method for diagnosing the disease. This is an endoscopic procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum. He can immediately perform a biopsy –take a piece of tissue with forceps for histological examination in order to clarify whether the detected neoplasm is cancer and what histological type the tumor has. It is usually an adenocarcinoma. Subtypes are also distinguished: in structure; the tumor may resemble stomach, colon, or bile and pancreatic duct cancers.

Endoscopic ultrasound is used to assess the depth of tumor invasion. During this procedure, an ultrasound transducer is placed in the patient's gastrointestinal tract. Doctors check how deeply the tumor has invaded the intestinal wall, and whether it has spread to adjacent organs. With the help of endoscopic ultrasound, the specialist can see swollen lymph nodes, which is a sign of metastasis.

Transabdominal ultrasound sometimes becomes the first examination by which the tumor is detected. The diagnostic examination is carried out with the placement of the transducer on the skin of the abdomen. The probability of detecting the neoplasm is high only when it reaches a size of more than 2 cm.

Computed tomography is used to assess the characteristics of the tumor, detect metastases, and clarify the stage of the disease.

Surgical treatment

The surgical treatment option for the patient with small intestine cancer is the most preferred. This is the only way to cure small intestine cancer completely. Doctors seek to remove the tumor with the capture of healthy tissue. It is important to achieve a negative resection margin so that cancer does not recur in the intestine. After surgery, radiation therapy and chemotherapy for the intestine may be required.

Pancreaticoduodenal resection. This is the most common surgery for duodenal cancer. It is the treatment of the first choice for small intestine cancer located in the second segment due to its proximity to the head of the pancreas, distal bile duct, and major duodenal papilla. In addition, large tumors of any other part of the duodenum are an indication of pancreaticoduodenal resection.

This is a traumatic, unsafe surgery on the intestine, which is best performed in specialized medical centers. Patient mortality and the risk of complications are several times higher in general hospitals.

When performing the operation, the doctor removes the affected part of the small intestine, the head of the pancreas, the gallbladder, and part of the duct, lymph nodes, and sometimes also part of the stomach. The surgery takes several hours. The doctor must not only remove the intestinal tumor completely, but it is also necessary to restore the integrity of the gastrointestinal tract and ensure normal digestion. Doctors connect the ends of the stomach to the small intestine. They connect the bile and pancreatic ducts to the intestines.

As a rule, this surgical intervention for duodenal cancer is performed through a large abdominal incision. In developed countries, doctors are increasingly operating on the intestines using a minimally invasive laparoscopic approach. With this treatment option, the incisions are smaller. The surgery provides a lower trauma rate, and treatment for duodenal cancer becomes safer for health. However, laparoscopic surgery in the treatment of small intestine cancer provides good oncological results only if performed by experienced surgeons who practice this type of surgery regularly, performing dozens of surgical interventions annually.

Segmental resection. This surgery is preferred, as it is more sparing, safe for health, provides a higher quality of life for the patient, and has a low mortality rate. The surgical intervention involves the removal of only a segment of the duodenum. The operation can be performed when the tumor develops in the first, third, or fourth segment of the duodenum, but only under the condition that the doctor can reach the negative resection margin. After the histological examination of the surgical material, there should be no tumor cells at the border of the removed intestinal tissue, since their presence is a risk factor for disease recurrence. The lymph nodes are removed simultaneously.

Some doctors are supporters of pancreaticoduodenal resection even in the early stages of duodenal cancer, and segmental resection is not performed at all. This is because more lymph nodes can be removed during pancreaticoduodenal resection. A large study involving 1611 patients confirmed that after pancreaticoduodenal resection doctors do indeed remove more lymph nodes. However, survival rates compared with segmental resection were found to be similar. Therefore, at present, this surgery has begun to be performed more often in developed countries. It is considered the first choice technique in situations where the negative resection margin is expected.

This is the possibility of complete tumor removal within healthy tissues that is the main factor affecting the effectiveness of treatment. The experience of Johns Hopkins University showed that with the negative resection margin, the five-year survival rate of patients operated on for duodenal malignancy is 58%. With the positive resection margin, the five-year survival rate dropped to zero.

Lymphadenectomy. It is a mandatory stage of any operation for small intestine cancer. Doctors must remove at least 6 lymph nodes to examine them for metastases. Whenever possible, they are removed in larger quantities.

Palliative surgery. It is performed when radical resection of the small intestine tumor is impossible. The main goal of such operations is not to cure cancer, but to prevent complications, and improve the patient's quality of life, and, possibly, life expectancy. Palliative surgical interventions on the small intestine are aimed at restoring the passage of the food bolus from the stomach into the duodenum; restoring the outflow of bile into the intestine, and relieving pain. Doctors in developed countries avoid traumatic surgery if they pursue palliative goals. They perform endoscopic procedures and laparoscopic interventions on the intestines and biliary tract. Typically, patients undergoing palliative procedures and surgical interventions have widespread large bowel tumors, regional and distant metastases, and poor health. Therefore, median survival in the palliative surgery group is 8 months.

Chemotherapy

Duodenal cancer is rare. Therefore, the schemes of its drug treatment are not standardized, and the indications for it are not finally defined. Doctors usually use the same schemes as for large intestine adenocarcinoma.

Chemotherapy is provided to all patients with advanced small bowel cancer who are not considered candidates for radical surgery. Medicines are used in the metastatic stage, with relapses, and large unresectable neoplasms. Chemotherapy increases the life expectancy of patients. The median survival reaches 20 months. Two-thirds of patients respond to treatment, with 10% having a complete response (disappearance of all tumors).

Data on the effect of postoperative chemotherapy on patient survival are conflicting. Therefore, in some centers it is prescribed, in other hospitals, after the surgery, the person does not receive drug treatment to prevent relapse. In most hospitals, chemotherapy after the removal of the portion of the small intestine with the tumor is performed only if there are risk factors for disease recurrence.

Radiation therapy

Radiation therapy is not used as a postoperative treatment option. No study has been able to prove a positive effect of this procedure on patient survival rates. Studies have only achieved better local disease control. Radiation helps reduce the risk of local recurrence. Therefore, radiation therapy after surgery may be useful in a limited number of cases: for example, if metastases are found in distant lymph nodes, then the remaining lymph nodes can be irradiated.

Most often, radiation therapy can be used as a palliative procedure in the advanced stages of cancer. With its help, doctors can reduce tumors and metastases to lower the risk of complications.

Why is it worth undergoing treatment abroad?

In countries with advanced medicine, you will find the highest level of medical care. You can recover from cancer with minimal health risks. You will be treated by the best doctors in the world, in well-equipped hospitals, with the use of the very latest methods and technologies.

Here are some advantages of treatment abroad: 

• whenever possible, preference is given to a less traumatic and safer operation: segmental duodenal resection (if complete tumor removal is expected);
• doctors remove more lymph nodes to reduce the risk of tumor recurrence;
• many hospitals perform laparoscopic operations;
• low mortality even with the most complex and traumatic interventions, including pancreaticoduodenal resection;
• quality adjuvant treatment in strictly selected patients in order to destroy remaining cancer cells and prevent a recurrence.

Treatment for intestinal cancer in Europe with Booking Health

To undergo treatment for small intestine cancer in one of the European hospitals, you are welcome to use the services of the Booking Health company. On our website, you can find out the cost of treatment and compare prices in different hospitals in order to book a medical care program at a favorable price. Treatment in Europe will be easier and faster for you, and the cost of treatment will be lower.

Please leave your request on the Booking Health website. Our specialist will contact you and consult you on treatment in Europe. Booking Health company will fully organize your trip to another country. We will provide the following benefits to you:

• We will select the best European hospital, whose doctors specialize in the treatment of small intestine cancer and achieve excellent results.
• We will solve the language barrier problem, and we will ensure communication with the doctor of the European hospital.
• We will reduce the waiting period for the medical care program. You will receive treatment for small intestine cancer on the most suitable dates.
• We will reduce the price. The cost of treatment in Europe for intestine cancer will be reduced due to the lack of overpricing and additional coefficients for foreign patients.
• We will solve any organizational issues: we will prepare documents, meet you abroad and take you to the hospital, book a hotel, and provide interpreting services.
• We will prepare the program and translate medical documents. You do not have to repeat the previously performed diagnostic procedures for examining the intestine. 
• We will help you keep in touch with doctors after the treatment completion
•  in Europe.
• We organize additional diagnostic examinations and treatment of the intestines in the European hospital.
• We will buy medicines abroad and forward them to your native country.

Leading doctors from around the world will deal with the health of your intestines. The Booking Health specialists will help reduce the cost of treatment, organize your trip to the European hospital, and you can fully focus on restoring your health.

Authors: 

The article was edited by medical experts, board certified doctors Dr. Vadim Zhiliuk and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Our editorial policy, which details our commitment to accuracy and transparency, is available here. Click this link to review our policies.

Sources:

National Library of Medicine

Web MD

Verywell Health