What are the signs of duodenal cancer?

Signs and Symptoms of Duodenal Cancer

The most common signs of duodenal cancer include abdominal pain, weight loss, vomiting, and jaundice when the tumor is located in the periampullary region. These symptoms often develop gradually and may be initially vague, leading to delayed diagnosis.

Common Presenting Symptoms

• Abdominal pain, particularly in the upper abdomen, is the most frequent symptom (56% of cases) 1
• Weight loss, often significant (>10 kg) and occurring over several months 2, 1
• Vomiting, which can be projectile when gastric outlet obstruction develops 3
• Jaundice, especially with tumors in the periampullary region that obstruct the bile duct 4
• Early satiety and feeling full quickly when eating, particularly with tumors causing obstruction 5
• Nausea, which may be persistent and refractory to standard treatments 3
• Diarrhea, which can occur in some cases 4
• Anorexia and general malaise 5

Symptom Presentation Based on Tumor Location

• Tumors in the first and second portions of the duodenum (periampullary region) are more likely to cause:

  • Jaundice due to bile duct obstruction 4
  • Pruritus (itching) related to biliary obstruction 4
  • Steatorrhea (fatty stools) due to pancreatic duct obstruction 5

• Tumors in the third and fourth portions of the duodenum more commonly present with:

  • Intestinal obstruction symptoms (vomiting, abdominal distension) 2
  • Abdominal pain that may be postprandial (after eating) 3
  • Less frequently with jaundice unless metastatic disease is present 5

Advanced Disease Indicators

• Complete obstruction of the duodenum, causing persistent vomiting 2
• Significant and rapid weight loss (>10 kg) 2, 1
• Palpable abdominal mass 5
• Thickening of the duodenal wall visible on imaging studies 2, 3
• Enlarged lymph nodes near major blood vessels 2
• Ascites (fluid in the abdomen), indicating advanced disease 5

Diagnostic Challenges

• Symptoms are often non-specific in early stages, leading to delayed diagnosis 5, 1
• The interval between first symptoms and diagnosis averages about four months 4
• Initial symptoms may be misinterpreted as more common conditions like peptic ulcer disease 3
• Duodenal cancer is rare, accounting for only 0.02% of all hospital admissions in one large study 1

Diagnostic Approaches

• Esophagogastroduodenoscopy (EGD) is the most effective diagnostic tool, detecting 88.6% of duodenal cancers 1
• Gastrointestinal barium radiography can detect 83.3% of cases 1
• CT scanning is essential for staging and can show duodenal wall thickening, luminal narrowing, and lymph node involvement 2
• Multiple biopsies during endoscopy are often needed, as superficial biopsies may miss intramural disease 3

Early recognition of these symptoms, especially in combination, should prompt appropriate diagnostic evaluation to improve outcomes, as surgical resection with negative margins offers the best chance for survival 1.