duodenal adenocarcinoma
Introduction
Introduction to duodenal adenocarcinoma Adenocarcinoma of duodenum (adenocarcinoma of duodenum) refers to adenocarcinoma originating from the duodenal mucosa, mostly single, can be caused by malignant transformation of adenoma. Histologically, adenoma-adenocarcinoma transformation and residual adenoma tissue in adenocarcinoma can be seen. basic knowledge Sickness ratio: 0.001%-0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: anemia
Cause
Cause of duodenal adenocarcinoma
Causes:
At present, the etiology of duodenal adenocarcinoma is not clear. Some substances secreted by bile and pancreatic juice, such as bile acid such as lithocholic acid, may be carcinogens, which promote the formation of tumors, familial polyposis. Gardner and Turcot syndrome, von Reeklinghausen syndrome, Lynch syndrome, benign epithelial tumors such as villous adenomas may be associated with the development of duodenal adenocarcinoma, and duodenal ulcers or malignant transformation of the diverticulum And genetic factors also have a certain relationship with duodenal adenocarcinoma.
Pathogenesis:
1. The site of good hair: duodenal adenocarcinoma occurs mostly in the lower part of the nipple, accounting for about 60%, followed by the lower part of the ampulla, the ball is the least seen.
2. Pathological morphology:
(1) Gross morphology: The general morphology of duodenal adenocarcinoma can be divided into polyp type, ulcer type, ring ulcer type and diffuse infiltration type, of which polyps type is the most common, accounting for about 60%, followed by ulcer type.
(2) Histomorphology: microscopic duodenal adenocarcinoma is mostly papillary adenocarcinoma or tubular adenocarcinoma. It is located near the duodenal papilla and is mostly polypoid papillary adenocarcinoma. Most other parts are tubular adenocarcinoma. It is an ulcer type or a ring-shaped ulcer type, and the lateral expansion of the ulcer lesion can cause a duodenal annular stenosis.
Prevention
Duodenal adenocarcinoma prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
1. Pay attention to food diversification and eat five or more kinds of vegetables and fruits every day. Scientific diet, mainly plant food (fresh vegetables, fruits, beans and whole grains, etc.), should account for more than 2/3 of each meal, eat more dairy products, fish and so on. Reduce salt and fat intake and spicy, irritating foods. Eat less sweets, fat meat, animal offal, fried foods, do not eat charred food, limit the consumption of pickled foods, bacon. It is best to cook, steam, and fry food. Do not eat foods that have been stored for too long at room temperature and may be contaminated with mycotoxins.
2. Perform regular physical examinations. Actively prevent and treat various acute and chronic intestinal diseases.
3. Participate in appropriate physical exercise, control weight, and develop a healthy lifestyle. Exercise 40-60 minutes per day, and it is advisable to go fast or similar intensity exercise.
4. Keep your mood comfortable. Integrate into normal life, work and social activities with physical strength.
Complication
Duodenal adenocarcinoma complications Complications anemia jaundice
The surgical resection rate was over 70%, and the 5-year survival rate after radical resection was 25% to 60%. However, the unresectable duodenal cancer has a poor prognosis, and the survival time is generally 4 to 6 months, and there is almost no long-term survival.
Symptom
Duodenal gland cancer symptoms Common symptoms Dull pain, black stool, upper abdominal discomfort, jaundice, abdominal pain, nausea, weight loss, nail-shaped, tuberculosis, anorexia
1. Clinical symptoms and signs
Early symptoms are generally not obvious, or only upper abdominal discomfort, pain, weakness, anemia, etc., its symptoms and signs are related to the disease course and the tumor site. According to the literature statistics, common symptoms and signs are as follows:
(1) Pain: It is similar to ulcer disease, which is characterized by upper abdominal discomfort or dull pain. The pain is not relieved after eating, and sometimes the pain can be radiated to the back.
(2) anorexia, nausea, vomiting: the incidence of non-specific symptoms of such digestive tract in duodenal adenocarcinoma is 30% to 40%, such as frequent vomiting, vomiting content, mostly due to the gradual increase of tumor blockage Intestinal cavity, caused by partial or complete obstruction of the duodenum, whether the vomiting contents contain bile can identify the obstruction site.
(3) anemia, bleeding: the most common symptoms, the main manifestations of bleeding is chronic blood loss, such as fecal occult blood, black stool; a large number of blood loss can vomit blood.
(4) Astragalus: caused by tumor obstruction of ampulla, such tumor caused jaundice often due to tumor necrosis, shedding caused by jaundice fluctuations, common in fecal occult blood positive after jaundice is also reduced; in addition, jaundice often accompanied by abdominal pain, above 2 points are different from the painless jaundice that is progressively worsened in pancreatic head cancer.
(5) Weight loss: This symptom is also more common, but progressive weight loss often indicates poor treatment.
(6) Abdominal mass: When the tumor grows large or invades the surrounding tissue, some cases may lick the right upper abdomen mass.
2. Clinical staging
Domestic duodenal adenocarcinoma has not been detailed in stages, and its staging method is mostly based on the staging method developed by the American Cancer Association.
(1) Clinical stage: In stage I, the tumor is confined to the duodenal wall; in stage II, the tumor has penetrated the duodenal wall; in stage III, the tumor has regional lymph node metastasis; in stage IV, the tumor has a long distance Transfer.
(2) TNM staging is:
T: primary tumor.
To: There is no evidence of primary tumor.
Tis: carcinoma in situ.
T1: The tumor invades the lamina propria or submucosa.
T2: The tumor invades the muscle layer.
T3: The tumor penetrates the muscle layer and infiltrates the serosa or passes through the muscle layer covered by the peritoneum (such as the mesenteric or posterior peritoneum) and infiltrates outward by 2 cm.
T4: Tumors invade adjacent organs and structures, including the pancreas.
N: local lymph node.
N0: no local lymph node metastasis.
N1: Local lymph nodes have metastasis.
M: Transfer in the distance.
Mo: No distant transfer.
ML: There is a distant transfer.
Examine
Duodenal adenocarcinoma examination
Laboratory inspection
1. Tumor mucin detection
It may indicate the source of tumor tissue. The ampullary cancer may originate in the mucosa of the duodenum wall, the pancreatic duct or the bile duct, and the prognosis may be different depending on the source site. Therefore, Dauson and Connolly analyze the mucin produced by the tumor to suggest the tumor. Tissue Source: Salivary Mucin The tumor from the real ampulla is characterized by the bile duct epithelium and duodenal mucosa; the neutral mucin is a characteristic secreted protein of the Bruner gland; the sulfated mucin is mainly produced by the pancreatic duct.
2. Histopathological examination
Tumors can be expressed as polyps, infiltrates and ulcers. Polypoid masses are soft, large cauliflower-like, and may also be derived from adenomatous polyps or villous adenomas. The edges of the tumor are bulge-like, hard, tumors. Invasive growth, can block the duodenal cavity caused by duodenal stenosis and obstruction, microscopic examination: duodenal cancer is mainly adenocarcinoma, accounting for 81.4%, a small number of cancer cells produce a lot of mucus Mucinous adenocarcinoma, even undifferentiated cancer with poor differentiation.
3. Fecal occult blood test
When the ulcer is the main disease, fecal occult blood can be positive.
Film degree exam
1. Air angiography
It is the preferred method of examination. For example, double contrast angiography can improve the diagnosis rate. Because of the different forms of cancer, the X-ray images have different characteristics. Generally, some mucosa is thick, the disorder or wrinkles disappear, the intestinal wall is stiff, and polypoids are also visible. Filling defects, sputum, duodenal stenosis, ampullary adenocarcinoma and ulcer-induced ampullary deformation similar, easy to be misdiagnosed.
2. Duodenal fiber endoscopy
Under the microscope, the mucosa of the lesion is ruptured, and the surface is covered with necrotic tissue. If the mucosa is rough and erosive at the top of the adenoma, cancer should be considered. For the suspicious part, multiple tissues should be taken for pathological examination to avoid missed diagnosis, because the fiber endoscope is difficult to peep. In paragraphs 3 and 4, the diagnosis may be missed, and the long-term endoscopic or barium meal may be used to make up for the deficiency.
3.B Ultra
Endoscopic ultrasonography and CT examination: local thickening of the intestinal wall can be seen, and the extent of tumor invasion, depth, lymph node metastasis in the surrounding area, and intra-abdominal organs such as the liver can be understood.
Diagnosis
Diagnosis and differentiation of duodenal adenocarcinoma
diagnosis
Because there is no special symptoms and signs in the early stage of the disease, the diagnosis mainly depends on the clinical auxiliary examination. The double angiography of duodenal fistula and fiber duodenoscopy is the main means of preoperative diagnosis of duodenal tumor.
Differential diagnosis
There are many diseases that need to be differentiated from duodenal adenocarcinoma, but depending on the main clinical signs, consider the identification of different diseases:
1. Patients with obstructive jaundice need to be differentiated from diseases such as pancreatic head cancer, cholangiocarcinoma, bile duct stones, and duodenal descending diverticulum.
2. Patients with vomiting or obstruction should be differentiated from duodenal tuberculosis, ulcerative pyloric obstruction, annular pancreas, and superior mesenteric artery syndrome.
3. Patients with gastrointestinal bleeding should be differentiated from tumors such as stomach, hepatobiliary, colon, pancreas, right kidney and retroperitoneal.
4. The upper abdomen is painful and needs to be differentiated from ulcer disease and cholelithiasis.
