Disease Overview
duodenalcarcinomais发lifeinduodenalmucosaofmalignant tumor，isprimarysmallintestinecarcinomain相forrareoftype。duodenalisdigestive道ulcer、tumorofgood发regionposition，butduodenalcarcinomaonlyaccounting fordigestive道malignant tumorof0.3%-0.5%，accounting forsmallintestinemalignant tumorof30%-40%。peak age of onset50-70years old，males略moreinfemales。due toduodenalAnatomypositionSpecial,positioninstomachand空intestineofInterval,againisbileandpancreasfluidof共samePassage,duodenalcarcinomaearly-stagesymptomsnot典type，easyanddigestivetypeulcer、chronicstomachConfused with inflammation,at diagnosismoreasadvanced-stage。
Major Causes
Adenomatous polyps：duodenalglandulartumorisimportantofprecancerous lesions，particularlyfamilial adenomatous polyposis(FAP)andPeutz-Jeghers syndromepatients。
chronic inflammation：Crohn's disease、chronicduodenalInflammation,celiac diseaseetc.long-termchronic inflammatory stimulationcanincreasingmalignant transformation risk。
Pancreatic diseases：chronicpancreaticInflammation,pancreaticcatheterinternalPapillacondition黏fluidtypetumor(IPMN)累andduodenaltimeincreased risk。
Anomalous pancreaticobiliary junction：congenitaltypegallbladderpancreatic duct汇combinedifferentnormalcausingpancreasfluidReflux,stimulationduodenalmucosa。
Genetic factors：Lynch syndrome(Lynchcomprehensivesign)、familial adenomatous polyposisetc.genetictypetumorcomprehensivesign。
Dietary habits：highfat、highprotein饮food，Alcohol consumption，Smokingetc.。
Helicobacter pyloriinfection：cancanincreasingincidence risk。
duodenalDiverticulum:long-termstimulationmay lead to恶change。
Common Symptoms
early-stagesymptoms：typicallynosignificantsymptomsormanifestationasnon-特differenttypeupper腹discomfort、digestiveadverse。
upperabdominal pain：the most commonsymptoms，persistentorparoxysmaladdheavy，andadvancefoodhaveclose。
jaundice：Tumor invadesampulla of Vaterorcommon bile ductunderDistal end,causingbiliary tractobstruction，appearingskin, Scleral icterus,small便deepJaundice, clay-colored stools.
digestive道bleeding：manifestationasMelena, hematemesis,oranemia、fatigue, Dizzinessetc.symptoms。
abdominalmass：advanced-stagecaninrightupperAbdominal palpationandmass。
obstructionsymptoms：
obstructive jaundice：biliary tractobstruction
duodenalobstruction：nausea、vomiting、abdominal distension，vomiting含bile
pancreaticobstruction：abdominal pain、steatorrhea、Diabetes
systemicsymptoms：body weightunderdecrease、food欲decreaseretreat、fatigue、feveretc.。
Pathological Classification
glandularcarcinoma(80%-90%)：mostcommon，includingpapillary adenocarcinoma、tubular adenocarcinoma、mucinous adenocarcinoma
carcinoid tumor(neuroendocrine tumors)：approximately10%-20%，relatively low degree of malignancy
肉tumor：leiomyosarcoma、gastrointestinal stromal tumor(GIST)etc.
lymphatictumor：primaryduodenallymphatictumor
othertype：squamous cell carcinoma、undifferentiated carcinomaetc.
TNM Staging(AJCC8th edition)
Primary Tumor (T)
Tis：Carcinoma in situ
T1：Tumor invadeslamina propriaorsubmucosa
T2：Tumor invadesmuscularis propria
T3：tumorPenetrationmuscularis propria达serosaunderornoperitoneumCoveringofintestine周tissue，<2cm
T4：tumorPenetration through the viscerallayerperitoneumordirectlyinvasionotherorganorstructure
Regional Lymph Nodes (N)
N0：No regional lymph node metastasis
N1：1-3regionallymph nodesmetastasis
N2：≥4regionallymph nodesmetastasis
Distant Metastasis (M)
M0：No distant metastasis
M1：Distant metastasis present
Clinical Stage Grouping
0stage：Tis N0 M0
Ⅰstage：T1-2 N0 M0
Ⅱstage：T3 N0 M0
ⅢAstage：T4 N0 M0
ⅢBstage：anyT N1 M0
ⅢCstage：anyT N2 M0
Ⅳstage：anyTanyN M1
Diagnosis
Laboratory tests：
血normalRoutine:anemia, Albumincellselevated
hepaticfunction：gallbladder红element, Transaminaseenzymeelevated
Tumor markers：CEA、CA19-9canelevated
Imaging studies：
upper gastrointestinal contrast：showduodenalFilling defect, narrowingnarrow
CTorMRI：assessmenttumorsize、invasionextent、lymph nodesmetastasis、distantmetastasis
ultrasoundinternal镜(EUS)：assessmenttumordepth of invasion，guidancepuncture biopsy
ERCP(endoscopic retrograde cholangiopancreatography)：showgallbladderpancreatic ductobstructioncondition，canproceedbiopsy
internal镜examination：
upper gastrointestinal endoscopy: Direct visualizationobservedtumorformstate, Obtainbiopsy
duodenoscopy：moregoodobservedPapillary regionandduodenaldecreaseregion
Prevention and Follow-up
regularlybodyExamination:high-riskpopulationregularlyperformedstomach镜examination
treatmentprecancerous lesions：resectionAdenomatous polyps，treatmentchronic inflammation
healthy diet：reducehighfat、highproteinfoodintake，moreEat vegetables and fruits
quit smoking and limit alcohol：reduceincidence risk
follow-up：postoperativelyfirst 2 yearsevery 3-6 monthsfollow-up examination，years 3-5every 6 monthsonce，after 5 yearsannuallyonce