Pancreatic Carcinoma

Posted by e-Medical PPT Friday, July 9, 2010
About 95% of exocrine pancreatic cancers are adenocarcinomas.The remaining 5% include adenosquamous carcinomas, signet ring cell carcinomas, hepatoid carcinomas, colloid carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with osteoclast-like giant cells.Exocrine pancreatic tumors are far more common than pancreatic endocrine tumors, which make up about 1% of total cases.
Presenting features of pancreatic carcinoma include:
* weight loss in 80%
* deep epigastric pain, which in 60% of cases, radiates to the back. It is a very hard pain to treat.
* jaundice with pruritus if tumour affects head of the pancreas and obstructs the biliary system; occurs in 50%
* ascites with a knobbly liver in 30%
* anorexia, nausea, vomiting
* palpable gallbladder - Courvoisier's law
Less common presentations:
* steatorrhoea
* thrombophlebitis migrans
* acute pancreatitis
* gastric outlet obstruction, causing pyloric stenosis
* gastrointestinal haemorrhage due to duodenal erosion
* symptoms of hypoglycaemia may occur if the tumour is an insulinoma - very rare
Liver function tests can show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, γ-glutamyl transpeptidase and alkaline phosphatase levels). CA19-9 (carbohydrate antigen 19.9) is a tumor marker that is frequently elevated in pancreatic cancer.

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