Epidemiology
The fourth leading cause of cancer death in US
3%
M>F
60-80yrs ( rare in under 40 )
Risk factors : family history of pancreatic cancer, hereditary o
r chronic pancreatitis, cigarette smoking, occupational expos
ure to carcinogen
Relationship with DM : controversial
Anatomy
Pancreas division
1) Major papilla : Duct of Wirsung(ventral pancreas)
2) Minor papilla : Duct of Santorini(sup head, neck, body,t
ail)
Blood supply
1) Gastroduodenal artery<==Celiac trunk
2) Pancreatoduodenal artery(ant & post)<==SMA
3) splenic artery <==Celiac trunk
Pathology
Ductal adenocarcinoma : 90 %
Head and uncinate process : 70 % among ductal adenocarci
noma
Hard, irregular, gritty mass, poorly demarcated, halo surroun
ds tumor d/t obstruction of duct
Perineural growth ; upper abdominal and back pain
Body or tail tumor ; larger and detected lately
Genetic consideration
codon 12 mutations of the K-ras oncogene (grwoth promo
ting oncogene)
inactivation of tumor suppressor genes ; p16, p53, SMAD4
excessive expression of growth factor receptor ; EGF-R
Up to 16% of pancreatic cancers are thought to be inherited
Diagnosis
Contrast- enhanced spiral CT : Choice
hypodense mass with poorly demarcated edge, have a more hypodense center indi
cating central necrosis or cystic change
Anastomotic leaks
-occurs in 15% to 20% of patients, from pancreatic anastomosis(pancre
atic fistula)
Intra-abdominal abscesses
Stage III
-Mean survival ranges from 8 to 12 months
Stage IV
-Mean survival ranges from 3 to 6 months
Reference
Sabistons Textbook of Surgery, 18th edition, 1589-1619
Harrisons Principles of Internal Medicine, 18th edition, 786-789 Freelove R, Walling AD Pancreatic cancer: diagnosis and management.
Am Fam Physician. 2006;73(3):48592 PubMed 16477897.
Johns Hopkins Medicine, The Whipple Procedure, (http://pathology.j
hu.edu/pc/whipplePop.php)
End of Document