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Adenocarcinoma of the small intestine complicating coeliac disease is uncommon. Only 14 cases have been reported, and in only one of these was a jejunal biopsy carried out more than eight months before the diagnosis of malignancy. We describe four more patients with this association, all with long histories of coeliac disease, confirmed in three by jejunal biopsy over five years before the diagnosis of malignancy. Important presenting features of carcinoma were abdominal pain, anaemia, occult gastrointestinal bleeding, abdominal mass, and intestinal obstruction, and these were the main indications for operation. After resection of the tumour survival may be prolonged, as evidenced by one of our cases who remains well eight years after surgery.

Serial CEA levels were measured in 157 patients with advanced inoperable gastric carcinoma entered in a controlled trial of cytotoxic therapy. In 49 (31%) of cases initial levels were greater than 50 ng/ml. However, serial measurements were only possible in 57 (36%) cases and results were prognostically valuable in only 15 (9.5%) of cases.

13175 patients with gastric carcinomas have been staged with reference to the TNM staging system. This has confirmed the poor overall prognosis (5·5 per cent and 3·8 per cent age-adjusted survival rates at 5 and 10 years respectively). However, it has demonstrated the significant survival associated with the treatment of Stage I disease (70·0 per cent at 5 years and 63·2 per cent at 10 years). This study demonstrates that 72·9 per cent of cases are unresected and that interpretation of resectability rates must be related to the population base of the study.

A prospective, randomized, controlled study of adjuvant chemotherapy in operable gastric cancer was commenced in 1976. Four hundred and eleven patients have been randomized into 1 of 3 treatment groups. Group A received a placebo injection of intravenous normal saline (10 ml) at 3-week intervals. Group B received a 5-day induction course of 5-fluorouracil (5-FU), vincristine, cyclophosphamide, and methotrexate followed by 3-week intravenous injections of 5-FU and mitomycin C (MMC). Group C received 3-week intravenous injections of 5-FU and MMC. The treatment was to be given for 2 years. Patients were stratified for age, sex, preoperative duration of symptoms, and clinicopathological stage prior to randomization. At this interim analysis, preoperative duration of symptoms and clinicopathological stage were statistically significant prognostic factors (p=

Serial CEA levels were measured in 157 patients with advanced inoperable gastric carcinoma entered in a controlled trial of cytotoxic therapy. In 49 (31%) of cases initial levels were greater than 50 ng/ml. However, serial measurements were only possible in 57 (36%) cases and results were prognostically valuable in only 15 (9.5%) of cases.

Summary The incidence of patients with gastric carcinoma having had a previously diagnosed or suspected peptic ulcer was noted in two studies. These studies were the West Midlands Gastric Chemotherapy Trial (1974–6) and a retrospective study of patients presenting to the United Birmingham Hospitals with gastric carcinoma during the years 1958–62 and 1968–72. The incidence of patients found to have had a previous operation for duodenal ulcer or to have post-mortem evidence of one was 6.5 per cent and 5.7 per cent respectively. A radiologically proved duodenal ulcer had been identified in 5.5 per cent and 2.1 per cent respectively and the incidence of previous symptoms suggestive of a duodenal ulcer was 4.0 per cent and 5.2 per cent. These figures indicate the total incidence could be 12.97 – 16.0 per cent, which is much higher than previously reported. The mean time interval between operation for duodenal ulcer and the development of gastric carcinoma was much longer in patients having had a partial gastrectomy than in patients having had a vagotomy and drainage procedure. The incidence of previous benign gastric ulcers was 2.5 per cent and 0.9 per cent. Fifty-three per cent of patients having had a previous operation for duodenal ulceration were found to have an unresectable carcinoma, compared with the overall unresectable rate of 35 per cent.

Adenocarcinoma of the gastric cardia has the worst prognosis of all sites, and treatment is often palliative. This study has reviewed 736 patients with carcinoma of the cardia registered with the Birmingham Cancer Registry during 1960–1969. Fifty-eight percent of the patients presented with advanced disease. Radical resection was accomplished in 265 (36%). The age adjusted 5-year survival for all patients was 4.5% and 9.8% for those undergoing radical resection. In patients with advanced disease, palliative resection was associated with a longer survival than for those treated by intubation (p < 0.001) and this difference was maintained even in the presence of liver or peritoneal metastases. There was no difference in the 30-day mortality rates for those undergoing palliative resection or intubation and it is suggested that resection be undertaken whenever possible.