Table 16.
Duodenal adenocarcinoma risk factors
| Element | Interpretation | Data and study |
|---|---|---|
| Spigelman stage IV | Risk factor | ⇑ among duodenal cancer: 15.3% versus 7.1% (P = 0.003)98 OR, 8.8; 95% c.i., 2.1–36.698 |
| Duodenal adenoma HGD | Risk factor | ⇑ among duodenal cancer: 29.4% versus 5.9% (P = 0.003)98 OR, 9.2; 95% c.i., 1.7–49.998 |
| Duodenal adenoma >10 mm | Risk factor | ⇑ among duodenal cancer: 76.5% versus 47.1% (P = 0.027)98 OR, 6.2; 95% c.i., 1.7–23.198 |
| Duodenal adenoma with tubulovillous or villous histology | Not risk factor | Similar among cases and controls (P = 0.43)98 OR, 1.9; 95% c.i., 0.4–3.498 |
| Papilla TV/V histology | Risk factor | ⇑ among duodenal cancer: 83.3% versus 22.4% (P < 0.001)98 |
| Papilla HGD | Risk factor | ⇑ among duodenal cancer: 25.0% versus 3.5% (P = 0.02)98 |
| Spigelman stage, at first endoscopy | Risk factor | 33% for stage IV, 13% for stage III, 12% for stage II, 0% for stage I and 0104 |
| Family history of CRC | Risk factor | ⇑ among duodenal cancer: 58.8% versus 33.3% (P = 0.048)98 |
| Family history of duodenal polyposis | Not risk factor | Similar risk of duodenal cancer99 |
| Personal history CRC | Risk factor Not risk factor |
⇑ among duodenal cancer: 22.2% versus 4.7% (P = 0.012)98 Similar duodenal cancer risk: OR, 1.331 (P = 0.56)110 |
| Personal history of desmoids | Not risk factor | Similar risk of duodenal cancer99 |
| Personal history of thyroid cancer | Risk factor | ⇑ among duodenal polyposis (P = 0.031)121 |
| Personal history of gastric cancer | Risk factor | ⇑among duodenal polyposis (OR, 6.260; 95% c.i., 1.504, 26.056)121 |
| Type of colon surgery | Risk factor Not risk factor |
⇑ risk of stage IV Spigelman for ileoanal anastomosis versus ileorectal anastomosis (P = 0.0029)116. Similar risk of duodenal cancer99 |
| Sulindac | Protective | ⇓ among duodenal cancer: 11.1% versus 41.2% (P = 0.016)98 |
| Celecoxib | Protective | ⇓ among duodenal cancer: 5.6% versus 32.9% (P = 0.019)98 |
| Ageing | Risk factor | Progressive increase in Spigelman stage111 Score: +0.30 points/year Stage: +0.12/year |
| Gastric polyposis | Risk factor | ⇑ among duodenal polyposis: OR, 2.814 (P = 0.024)110 |
| Sex | Not risk factor Not risk factor |
Similar duodenal cancer risk110 Similar risk of duodenal cancer99 |
| Age at diagnosis of FAP | Not risk factor Not risk factor Risk factor Not risk factor |
OR 0.438 (P = 0.124)110 Similar risk of duodenal cancer99 ⇑among duodenal polyposis (OR, 0.963; 95% c.i., 0.937, 0.990)121 Similar risk of duodenal polyposis127 |
| COX-2 polymorphisms | Not risk factor | Similar distribution of Spigelman stages124 |
| UGT and GST polymorphisms | Not risk factor | Similar distribution of Spigelman stages334 |
| Pregnancy | Variable | ⇑ among polyposis stage III/IV, but only if APC mutations before codon 1020 (50% versus 0%, P = 0.005)105 |
| APC mutation site | Risk factor Not risk factor Not risk factor Not risk factor Not risk factor |
⇑ polyposis risk if at codon 3183–3187121 Similar duodenal cancer risk98 Similar duodenal cancer risk99 Similar duodenal cancer risk104 Similar risk of duodenal polyposis127 |
CRC, colorectal cancer; FAP, familial adenomatous polyposis; HGD, high-grade dysplasia; TV/V, tubulovillous or villous.