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Clinical Skills Blogspot

Carcinoma of the Pancreas

Title               

Ñ    Carcinoma of the Pancreas

Definition

Ñ    Carcinoma arising from the pancreatic epithelium

Pathogenesis

Risk Factors

Ñ    Cigarette smoking

Ñ    Naphthalamine:

Petroleum product

Ñ    Chronic pancreatitis

Ñ    Females with diabetes mellitus

Ñ    Chemists

Pathological Process

Ñ    Adenocarcinoma

Ñ    Small and ill defined or large with extensive local and regional spread

Ñ    75% pancreatic head, 10-15% body, 10% tail

Clinical Features

History

Sex

Ñ    Males > Females

Age

Ñ    Incidence increases with age

E&M

Ñ    Weight loss

GIT

Carcinoma of the head:

Ñ    Painless jaundice

Ñ    Pain:

Later, as the tumour grows

Radiation to the back

Carcinoma of the body and tail:

Ñ    Abdominal pain

Ñ    Anorexia

Examination

E&M

Ñ    Weight loss

IS

Ñ    Jaundice

Ñ    Excoriations

Ñ    Skin nodules

CVS

Ñ    Thromboembolic phenomena

GIT

Ñ    Palpable gall bladder:

Courvoisier’s sign

Ñ    Abdominal mass

Ñ    Hepatomegaly:

Metastatic disease

Investigations

Fluids

Blood

Biochemistry

Ñ    Liver function tests

Cholestatic

Markers:

Ñ    CA 19.9

Ñ    CA 242

Imaging

Abdominal ultrasound

Ñ    Define tumour

Ñ    Show dilated bile ducts

CT scan

Ñ    Define tumour

MRI

Ñ    Define tumour

Endoscopy

ERCP

Ñ    Imaging

Ñ    Cytology:

Brushings

Management

Control

Drugs

Ñ    Chemotherapy:

·          Adjuvant to surgery:

Unresectable cancer

Surgery

Ñ    Curative resection

Ñ    Palliative resection

Ñ    ERCP and palliative stenting:

Relieve obstruction

Radiotherapy

Ñ    Adjuvant therapy

Ñ    Treatment for unresectable cancer

Prognosis

Ñ    Poor

Ñ    Most cases management is palliative

 

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