A case of rapidly progressive duodenal cancer

A 67-year-old man was referred to our department because of tumor marker outliers pointed out by his nearby physician, whom he had visited for epigastric pain. Upper gastrointestinal endoscopy revealed an irregular mucosa on the posterior wall of duodenal bulb and was diagnosed as a primary duodenal cancer (adenocarcinoma) by biopsy. However, a contrast-enhanced computed tomography (CT) showed many small nodules considered compatible with liver metastasis that limited effectiveness of surgery. And then, he was admitted to this department for his tarry stool and rapidly progressive anemia. A CT scan showed a rapid progression of both primary tumor and liver metastasis compared to a month before. On the 9th hospital day he had a large amount of melena considered intractable to endoscopic hemostasis or interventional radiology. Therefore, octreotide was administered for his symptomatic relief, and then melena and the need of blood transfusion were reduced. However, he gradually developed conscious disturbance and tumor fever, and died on the 26th hospital day. Octreotide reduced the bleeding from the terminal duodenal cancer and provided effective symptomatic relief of acute hemorrhage.