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Forum Name: Gastroenterology Topics

Question: duodenal cancer?


 bearman01 - Wed Jun 09, 2010 2:17 pm

Hello, i am an 18 year old male thats been having preexisting GI issues for years now. i was first diagnosed with acid reflux at an early age. but now entering adult hood my GI problem have increased substanially. for months i was experiencing severe bouts of having dark blood in my stool and on the toilet paper. i had a multitude of procedures done to try and figure it out the reason why this was happening. a meckels scan was done, twice, but due to the 15% success rate of the test, a laproscopic explaratory surgery was done to locate a meckels diverticulum. nothing was found, but the bleeding was miraculously ceased. months later i was experiencing excruciating stomach pain after eating with nausea and vomitting. my doctor discovered my gall blader was innactive so that was then later removed. several months pass and my symptoms become worse. the blood in the stool returns, abdominal pain keeps getting worse, bowel movement changes from diarrhea to constipation (back and forth), severe fatigue, bloating, humiliatingly theres also a malable smell that no matter whats done its impossible to mask. also after eating, it doesnt matter but i have to use the restroom. among all these tests i had a colonoscopy that showed a sessile polyp and lymphoid hyperplasia that was all a year ago. i recently had a endoscopy that revealed moderate gastritis and a tubular adenoma found in the duodenom, which i heard was extremely rare and is normally cancer. but my doctor said he wants to wait 6 months because its a "fluke" and see what happens. should i get a second opinion? is it cancer? should i be concerned?
 Dr.M.Aroon kamath - Mon Jul 05, 2010 2:15 pm

User avatar Hi,
In a given population, Gastric, duodenal and periampullary polyps quite commonly occur in individuals with Familial adenomatous polyposis syndrome. Polyps in the duodenum are not common in the rest of the general population. When they are discovered, there is always a lingering suspicion of presence of polyps lower down in the gastrointestinal tract(colon).

Hyperplastic polyps are innocent - they do not have any malignant potential and there is no need for removal of a polyp like this.

Adenomatous polps have an inherent risk of malignant change (an "adenoma-carcinoma sequence" is well accepted and increasingly being studied).

World Health Organization (WHO) criteria for colonic polyps (Based on the % of the villous component):
- villous adenomas have >80% of villous component (5% of all cases),
- tubular adenomas-are most common (80-86% of all cases).
- tubulovillous adenomas (8-16% of all cases).

The malignant potential is highest for villous polyps (40%) and
lowest for tubular polyps (5%), with an intermediate risk for tubulovillous polyps (22%).
The malignant potential may also be described pathologically
as the degree of “dysplasia”. The more severe the dysplasia, the greater the risk of malignancy.
Adenomas that are greater than 1 cm, contain a substantial (>25%) villous component, or have high-grade dysplasia are commonly referred to as advanced neoplasms and carry a higher cancer risk.

Although rare, villous adenomas of the duodenum particularly at the ampulla, can occur. Villous adenomas are of concern primarily because of the higher risk of malignant transformation(especially for those >2cm)

The prevalence of adenomas closely parallels the risk of colorectal cancer in a given region.

You have not mentioned the details of the polyp (size & histopathology report). If it was a tubular adenoma without any dysplasia, & if it had been completely removed,the malignant risk is very small.

As you are complaining of multiple symptoms pertaining to the abdomen, it may be advisable to consult a gastroenterologist and possibly undergo a repeat colonoscopy.
Best wishes!
 zurc - Thu Jul 08, 2010 4:45 am

i experienced a stomach pain for 3 days. i also bowel that is liquid. I had a check up and the doctor said i need to take Ranitidine Hydrochloride 150 mg tablet twice a day for 2 weeks. I am not sure if he really diagnosed me correctly and I want a second advice so i decided to make a post here. on the fourth day ( i already taken 3 Ranitidine Hydrochloride 150 mg tablet) my stomach pain is not that hurting anymore but every time after eating, my stomach starts to ache. I need to know if a already have an ulcer. thanks for your help in advance...
 Dr.M.Aroon kamath - Mon Jul 19, 2010 2:47 am

User avatar Hi zurc,
It is better not to jump to sudden conclusions. I feel that you should consult your regular family doctor first who will fully examine you and get some of the basic tests (ex; a stool routine, blood counts, urinalysis) done. If indicated, your doctor will surely advise you about the next step.
Best wishes!

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