title: Hepatocellular carcinoma with duodenal invasion and metastasis.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) is the leading cause of cancer-related deaths in Taiwan. HCC with duodenal involvement are rare and are associated with a poor prognosis. The purpose of this retrospective study was to collect clinical information and data regarding survival following various treatments.
  
  
  METHODS
  Between 1996 and 2009, 21 cases (17 men) were diagnosed with HCC and duodenal invasion and metastases by diagnostic imaging, endoscopy with biopsy, or surgically collected specimens sent to pathology. The clinical course was analyzed from the patients' medical records.
  
  
  RESULTS
  Gastrointestinal bleeding was reported in 18/21 patients. Diagnostic imaging showed that the majority of cases involved direct tumor invasion (predominantly from the right liver lobe) and six cases from metastasis. Tumor mass and ulcerations were the most common features noted on endoscopy. In addition to the component therapy and medication treatment, panendoscopic hemostasis, surgery, transcatheter arterial embolization, and radiotherapy were performed for the management of duodenal involvement and gastrointestinal bleeding. Survival duration after duodenal involvement ranged from 0.2 to 57.8 months (mean 10.5 months).
  
  
  CONCLUSIONS
  Gastrointestinal bleeding in advanced HCC should raise suspicions of duodenal involvement. HCC can involve the duodenum by direct invasion (from either the left or right liver lobes) or metastasis. The prognosis for HCC patients with duodenal involvement is poor, but is improved by supportive care and application of various treatment modalities.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Ja-Der
authors.initials: JD
authors.lastname: Liang
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Shih-Jer
authors.initials: SJ
authors.lastname: Hsu
authors.forename: Jin-Chuan
authors.initials: JC
authors.lastname: Sheu
authors.forename: Pei-Ming
authors.initials: PM
authors.lastname: Yang
authors.forename: Hsuan-Shu
authors.initials: HS
authors.lastname: Lee
authors.forename: Cha-Ze
authors.initials: CZ
authors.lastname: Lee
authors.forename: Guan-Tarn
authors.initials: GT
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy; D004379:Duodenal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed