Duodenal Cancer Prevention: Risk Reduction and Early Detection

No Guaranteed Prevention, But Risk Reduction Is Possible

Duodenal adenocarcinoma is rare (<1% of GI cancers). Risk factors are modifiable and non-modifiable.

Modifiable Risk Factors

• Diet: High red/processed meat, low fiber/fruit/veg → ↑ risk. Mediterranean pattern protective.
• Obesity: BMI ≥30 → chronic inflammation, insulin resistance.
• Smoking: Dose-dependent risk increase.
• Alcohol: Heavy use → ↑ risk.
• H. pylori: Eradication may reduce duodenal cancer (evidence stronger for gastric).
• Occupational exposures: Certain chemicals (limited evidence).

Non-Modifiable / Medical Risk Factors

• Familial adenomatous polyposis (FAP) → near 100% duodenal adenomas; surveillance mandatory.
• Lynch syndrome (MSH2/MLH1).
• Peutz-Jeghers syndrome.
• Celiac disease (↑ lymphoma, adenocarcinoma risk).
• Crohn's disease (small bowel involvement).
• Prior radiation.

Surveillance for High-Risk Groups

• FAP: Upper endoscopy (side-viewing duodenoscope) every 1–3 years starting age 20–25.
• Lynch/PJS: Per syndrome guidelines.
• Celiac: Consider endoscopy if refractory symptoms.

Symptoms Warranting Urgent Evaluation

• Epigastric pain, weight loss, anemia, nausea/vomiting, melena, jaundice (ampullary).