Carcinoma of the duodenum

Investigations on the significance of the adenoma-carcinoma sequence in the small bowel

In view of the rarity of small-bowel epithelial neoplasms as compared with the case for the large bowel, evidence for an adenoma-carcinoma sequence in the small bowel was studied based on a search for data in the medical literature for the years 1927 through 1986. Sufficiently defined data were found for comparison of 185 benign adenomas, 76 adenoma-with-carcinomas, and 1333 carcinomas in patients without familial polyposis disease and for 63, five, and 30, respectively, in patients with disease. For patients without polyposis, it was found that (1) 29.8% of all small-bowel adenomas (33.6% if those at Vater's ampulla are excluded) showed malignancy; (2) the mean and median ages were lower for benign adenoma than for adenoma-with-carcinoma and carcinoma, although the ratios by sex were the same; (3) there is a nearly identical spatial distribution of the three types of epithelial neoplasms within the small bowel; and (4) both the frequency of finding adenomatous residues existing in continuity with carcinoma and the life history of the adenoma-carcinoma sequence are similar in the small bowel as in the large. In comparing these results with those from patients with familial polyposis disease, it was particularly noted that (1) the only difference was that adenomas in familial polyposis occurred earlier and multiply, and (2) the spatial distributions of adenomas and carcinomas for both cases were closely similar. It is therefore postulated that the adenoma-carcinoma sequence is as significant in the small bowels as in the large. A hypothesis regarding the relationship of epithelial neoplasms in people with and without familial polyposis disease is suggested.

Primary adenocarcinoma of the duodenum

Primary adenocarcinoma of the duodenum is rare. An extensive experience with fiberoptic esophagogastro-duodenoscopy in our institution has indicated that duodenal neoplasms may be more frequent than suspected and are readily diagnosed by this modality. With this mind, clinical, pathological, diagnostic and therapeutic aspects of the 71 patients with primary carcinoma of the duodenum reported in the literature in the last 10-year period, 1965-1974, were reviewed. It would appear that fiberoptic endoscopy of the upper gastro-intestinal tract should become the major diagnostic tool for this disease. It enables biopsies, brushings and washings to be taken. A preoperative histological diagnosis ensures that both patient and surgeon can be prepared for major abdominal surgery. It is imperatire that during the endoscopic examination, the entire duodenum be examined. Pancreatico-duodenectomy appears to offer the best chance of long term survival in patients whose lesion is resectable. The role and value of adjuvant chemo- and radiotherapy is still to be determined.

Carcinoma of the duodenum: comparison of surgery, radiotherapy, and chemotherapy

Three cases of infra-ampullary carcinoma of the duodenum are presented, and in each case the management was different.

A new method of reimplantation of the common bile-duct and pancreatic duct is described.

One hundred and twenty-six cases from reports in the past decade have been reviewed, and the distribution, sex ratio, clinical features, investigations, management, and prognosis are discussed.

In polyposis investigation of the upper gastrointestinal tract is advised.

The use of radiotherapy and chemotherapy is discussed and advocated.

Carcinoma of the duodenum

Five patients with carcinoma of the second part of the duodenum, presenting with obstructive jaundice, are discussed. The diagnosis was established at operation and radical surgery was not possible in any case. Local excision of the tumour and the adjacent duodenal wall with reanastomosis of the bile-duct and pancreatic duct to the duodenum were performed. Three patients died from the disease within 1 year of operation and 2 patients are still alive 16 and 18 months after operation. The clinical features of this disease are reviewed.

Carcinoma of the third part of the duodenum

A case of carcinoma of the third part of the duodenum is described in which it was possible to carry out a duodenectomy. The pancreatic and common bile-ducts entered the duodenum separately and the pancreatic duct required reimplantation into the duodenum. The problems involved in this reimplantation are discussed.

The radiology of small bowel lesions

The techniques of radiological examination of the small bowel are considered.

The importance of the routine barium meal and follow-through examination is stressed.

The vast majority of lesions present a diagnostic problem in interpretation rather than in detection.

Some examples of small bowel pathology are discussed and the need for interpretation in the light of the clinical picture is emphasized.

Important radiological signs to be appreciated are considered.