Alfred I. Neugut, MD, PhD

Dr. Yee and his colleagues have offered a comprehensive overview of the epidemiology, diagnosis, and therapy of both gallbladder carcinoma and cholangiocarcinoma. They correctly note the infrequency of these two neoplasms, with approximately 7,500 cases diagnosed in the United States each year, two-thirds of which are gallbladder cancer. Unfortunately, neither the incidence rate nor prognosis of these neoplasms has changed substantially since biliary tumors were last reviewed in this journal[1]; the median 5-year survival rate has remained at 5%. Some progress has been made, however, in our understanding of the etiology of cancers of the biliary tract, and a body of literature continues to emerge exploring the question of how best to approach screening and prophylaxis in high-risk populations.

Even though the small intestine contains 90% of the gastrointestinal tract mucosa and is located between the stomach and large intestine, two organs with a high cancer incidence, adenocarcinoma of the small intestine is 1/50th as common as adenocarcinoma of the large bowel. In several other respects, small-intestinal adenocarcinoma resembles large bowel adenocarcinoma; eg, it arises from adenomatous polyps, co-occurs in the same individuals, and has a similar pattern of incidence rates by country. Small-intestinal adenocarcinoma is diagnosed prior to surgery in only about 50% of cases and often occurs in conjunction with small bowel obstruction. The mainstay of treatment is surgery; prognosis depends on stage at presentation. Little is known about the use of radiotherapy and chemotherapy in this malignancy, but most physicians utilize therapeutic strategies modeled on the management of large-intestinal adenocarcinoma. Clarification of the reason for the low incidence of small-intestinal adenocarcinoma could lead to new interventions for the prevention of colorectal cancer. [ONCOLOGY 11(4):529-536, 1997]

Carcinoma of the gallbladder is a rare malignancy, with an incidence rate in the United States of 2.2 to 4.4 per 100,000 persons. Its clinical presentation is nonspecific, and the majority of patients have advanced disease at