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Duodenal Carcinoma: Its Relationship to Duodenal Ulcer

Duodenal Carcinoma: Its Relationship to Duodenal Ulcer Duodenal Carcinoma: Its Relationship to Duodenal Ulcer I. S. Startz , M.D. Boro of Queens, N. Y. Excerpt THE subject of carcinoma is always a vital consideration, especially in view of the fact that so little is known as regards its etiology and specific treatment, and that it has taken second place (3) as cause of death in our U. S. mortality statistics. And to go further, there is the realization that 75 per cent of all cancer cases occur in some part of the digestive system (6). It is a surprising fact that two-thirds of the entire alimentary tract, namely, the small intestine, is almost immune from carcinomatous implantation. Primary carcinoma of the duodenum is a rarity. Eger (8), in collecting data from general autopsies totalling 350,286 cases, reports primary carcinoma of the duodenum in only 0.033 per cent of cases. Herman and Von Glahm (11), in their average incidence from autopsy combined figures by Max Müller, Perry and Shaw, Northnagel, Ruepp, Tieman, and Fritz Müller, quote a surprising and almost similar percentage of 0.035. It is customary to divide the duodenum into the first or supra-ampullary portion, the second or ampullary portion, and the third or infra-ampullary portion. Of the three divisions of the duodenum, 70 per cent of the cases reported (4) occur in the ampullary portion, 18 per cent in the supra-ampullary portion, and 12 per cent in the infra-ampullary portion. The duodenum is attacked almost as frequently as the jejunum and ileum combined. The graphic chart (Fig. 1) has been compiled from average available statistics. It portrays more vividly the anatomic incidence of duodenal cancer in relation to other cancers of the gastro-intestinal tract, and to cancers as a whole. Explanation Offered for Infrequency of Carcinoma of the Small Intestine .—Just why the small intestine should be relatively cancer-resistant, and the other parts of the alimentary tract, particularly the stomach, cancer-sensitive, is difficult to explain. The two contiguous portions of the pars pylorica and the duodenal cap do not present any sharp demarcation in the histologic appearance of the mucous membrane. Piersol's anatomy describes a “gradual” transformation in the structure of the mucous membrane between the two. Eventhe pyloric sphincter cannot always be recognized by the surgeon as the division line without utilizing the pyloric veins as a landmark (17). Nevertheless, the pyloric sphincter is the gate between the pre-pyloric cancer zone and the post-pyloric non-cancer zone. Let us, therefore, discard the histologic study, and consider the matter from the physiologic viewpoint. The motility of the chyme is greater in the small intestine than in any other part of the gastro-intestinal tract. The average time required for the passage of food through the twenty feet of small intestine is four and three-eighths hours (13). Copyrighted by The Radiological Society of North America, Inc. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Radiology Radiological Society of North America, Inc.

Duodenal Carcinoma: Its Relationship to Duodenal Ulcer

Radiology , Volume 25 (6): 688 – Dec 1, 1935

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References (4)

Publisher
Radiological Society of North America, Inc.
Copyright
Copyright © 1935 by Radiological Society of North America
ISSN
1527-1315
eISSN
0033-8419
DOI
10.1148/25.6.688
Publisher site
See Article on Publisher Site

Abstract

Duodenal Carcinoma: Its Relationship to Duodenal Ulcer I. S. Startz , M.D. Boro of Queens, N. Y. Excerpt THE subject of carcinoma is always a vital consideration, especially in view of the fact that so little is known as regards its etiology and specific treatment, and that it has taken second place (3) as cause of death in our U. S. mortality statistics. And to go further, there is the realization that 75 per cent of all cancer cases occur in some part of the digestive system (6). It is a surprising fact that two-thirds of the entire alimentary tract, namely, the small intestine, is almost immune from carcinomatous implantation. Primary carcinoma of the duodenum is a rarity. Eger (8), in collecting data from general autopsies totalling 350,286 cases, reports primary carcinoma of the duodenum in only 0.033 per cent of cases. Herman and Von Glahm (11), in their average incidence from autopsy combined figures by Max Müller, Perry and Shaw, Northnagel, Ruepp, Tieman, and Fritz Müller, quote a surprising and almost similar percentage of 0.035. It is customary to divide the duodenum into the first or supra-ampullary portion, the second or ampullary portion, and the third or infra-ampullary portion. Of the three divisions of the duodenum, 70 per cent of the cases reported (4) occur in the ampullary portion, 18 per cent in the supra-ampullary portion, and 12 per cent in the infra-ampullary portion. The duodenum is attacked almost as frequently as the jejunum and ileum combined. The graphic chart (Fig. 1) has been compiled from average available statistics. It portrays more vividly the anatomic incidence of duodenal cancer in relation to other cancers of the gastro-intestinal tract, and to cancers as a whole. Explanation Offered for Infrequency of Carcinoma of the Small Intestine .—Just why the small intestine should be relatively cancer-resistant, and the other parts of the alimentary tract, particularly the stomach, cancer-sensitive, is difficult to explain. The two contiguous portions of the pars pylorica and the duodenal cap do not present any sharp demarcation in the histologic appearance of the mucous membrane. Piersol's anatomy describes a “gradual” transformation in the structure of the mucous membrane between the two. Eventhe pyloric sphincter cannot always be recognized by the surgeon as the division line without utilizing the pyloric veins as a landmark (17). Nevertheless, the pyloric sphincter is the gate between the pre-pyloric cancer zone and the post-pyloric non-cancer zone. Let us, therefore, discard the histologic study, and consider the matter from the physiologic viewpoint. The motility of the chyme is greater in the small intestine than in any other part of the gastro-intestinal tract. The average time required for the passage of food through the twenty feet of small intestine is four and three-eighths hours (13). Copyrighted by The Radiological Society of North America, Inc.

Journal

RadiologyRadiological Society of North America, Inc.

Published: Dec 1, 1935

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