Adenocarcinoma of the duodenum

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Adenocarcinona and other small-bowel neoplasms

• Although small bowel mucosa represents about 90% of mucosal surface of the alimentary tract, only 1%-5% of all gastrointestinal neoplasms arise there.
• The most common primary neoplasms are: adenocarcinoma, carcinoid, lymphoma and gastrointestinal stromal tumors (GIST).
• Adenocarcinoma represents the most common subtype in Europe (it accounts for approximately 40% to 50% of all small bowel neoplasms).
• Adenocarcinomas tend to accure in the duodenum, while carcinoids and lymphomas in the ileum or jejunum
• Among secondary neoplasms, very often are metastases of malignant melanoma, metastases from breast, lung and renal cancer.
• Some risk factors have been identified for small bowel adenocarcinoma: Crohn´s disease, small bowel adenomas, hereditary bowel polyposis and nonpolyposis syndromes (FAP, HNPCC), other GI tract cancer, smoking, alcohol use, radiation exposure, cholecystectomy.
• Lymphomas are more common in patients with celiac disease.
• Small bowel neoplasms have usually long asymptomatic course and so the diagnosis is often delayed.
• Small bowel neoplasms may present with nonspecific symptoms such as weight loss and abdominal pain, or with bleeding and acute obstruction.
• Small bowel neoplasms shoud be considered in cases of unexplained GI bleeding, anemia and even unexplained abdominal symptoms.
• Diagnostic work up: small bowel series or enteroclysis, computed tomography, enteroscopy, capsule endoscopy (VCE).
• Several studies have shown that performance of VCE is superior to that of other diagnostic modalities in detecting vascular lesions, inflammation and tumors of the small bowel.
• VCE plays a key-role in the diagnostic work up of obscure GI bleeding.

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A case of adenocarcinoma of the distal part of the duodenum, in a patient with obscure anemia and weight loss, is presented.