PRIMARY DUODENAL CARCINOMA

Eight cases of primary duodenal carcinoma in a district general hospit al are presented. The cases highlight the advanced state of the diseas e at presentation, the difficulty in diagnosis, and its poor prognosis . Duodenal carcinoma occurs in both sexes worldwide with no predisposi ng factors in the majority of cases. There is an increased risk in pat ients with familial adenomatous polyposis and adenomas of the duodenum Duodenal carcinoma occurs about 22 years from the diagnosis of famili al adenomatous polyposis in about 2% of patients, forming over 50% of upper gastrointestinal cancers occurring in these patients. Carcinomat ous changes occur in 30 to 60% of duodenal villous adenomas and much l ess in tubulo-villous and tubular adenomas. These categories of patien ts should be screened and adequately followed up. Aggressive and radic al surgery, even in the presence of locally advanced disease and lymph node involvement, gives a better outcome. When curative surgery is no t possible, chemotherapy must accompany palliation with or without rad iotherapy. Pre-operative chemotherapy may facilitate a curative radica l resection. The general five-year survival is 17-33% but some centres have achieved a five-year survival of 40-60% with aggressive manageme nt of these patients.