Duodenal Cancer - What is it?

A layperson's attempt to explain one of the rarest cancers going around.

Duodenal cancer is rare. So rare that it is the only cancer that doesn't have a MySpace entry, and its wikipedia entry is more about other cancers of the small intestine than it is about duodenal cancer. This cancer will occur for about 50 people in Australia (pop. 20M) this year. As a contrast, over 500 people will share in a major Lotto prize in the same period (I know which odds I'd rather have!). Both Google and Yahoo have a small duodenal cancer group, both of which have less than 20-30 active members from around the world.

The onset of symptoms (which I am not going to attempt to list) can occur anywhere between 3-4 years before diagnosis to, in my own case, two weeks! My own symptom was that I vomitted up two days accumulated food, three times!

The default treatment for duodenal cancer, if it can be operated on, is a dreadful piece of surgery called a Whipple's Procedure, in which the bottom part of the stomach, the gall bladder, the head of the pancreas, and the whole duodenum are removed. The jejunum is then pulled up and attached to the stomach, and the various bile ducts which used to feed into the duodenum are replumbed. The operation can take anywhere between 8-12 hours, and needs an experienced surgeon for safety. Success rate on the table is currently at around 95%. But when you read the stats on the John Hopkins site, the picture is different for long termers. 56% still around after 1 year, 26% after 3 and 21% after 5 years. A bit grim - as one of my GITs said, "you don't meet many people walking the streets who have had a Whipples".

BUT, there are stats and stats. I understand that most Whipples are done on people who have other types of much more aggressive and invasive cancers, such as pancreatic cancer. Once again, the rarity of duoedenal cancer works against information flow! But I still have this sneaking suspicion that I've dodged a bullet in not being operable - this puts me in charge of my own destiny to a greater degree).

Hospital time is usually around 2 weeks, followed by anywhere up to three months off work. There seem to be a number of versions of the Whipple's, but make no mistake, it is one of the worst surgeries going around (but better than the alternative!).

After the Whipple's, people seem to be generally eating okay again, although usually in smaller and more frequency amounts, within the three months.

If the cancer is inoperable, and this is usually becuase it has been caught late, or in my case is in the very busy area of the third part of the duodenum, then chemo and or radiotherapy are tried, sometimes in concert. The aim of the therapies is at least to stop the cancer, and possibly to shrink it, thus making it operable. Inoperable cancers are by definition incurable, because the only sure way to beat cancer is to cut it out! But even incurable cancer can be successfuly managed, if the stars are aligned properly. Many people live successful and long lives with cancers still in their bodies. Some don't.