Diseases of the Diseases of the PancreasPancreas

67 y old male with loss of appetite, gradual weight loss and dyspepsia.Recent onset of jaundice and dark urine.

Pancreatic cancer

• 4th most common cancer-related death

• Mainly adenocarcinoma

• Persons 60-80 yrs

• 5 year survival < 4%

Pancreatic cancer

• Smoking

• Chronic pancreatitis

• Obesity

• Diabetes

• Family history

• Cystic lesions (IPMN/MCA)

Risk factors:

Pancreatic intraepithelial neoplasia (PanIN 1-3)

Pancreatic adenoCa

• Head>whole gland>body>tail

• Lesions of head/ampulla > jaundice, Courvoisier’s gallbladder

• Often invade surrounding structures (inoperable)

Pancreatic cancer

• Anorexia, Weight loss

• Painless jaundice

• Chronic back pain

• Depression

• Thrombophlebitis

Symptoms:

Pancreatic cancer

• Elevated serum CA 19-9

• CEA

• Diabetes mellitus

Laboratory findings:

Pancreatic cancerdiagnosis

US, CT, EUS, ERCP, MRI

CT

Endoscopic UltraSonography (EUS)

EUS + FNA

MRI

ERCP

Pancreatic cancer - treatment

Surgical resection:

Resectability determined by:1) no metastases2) no invasion of porta hepatis, portal vein behind body of pancreas, SMA region3) no spread to liver or other peritoneal structures

Pancreatic cancer - surgical therapy

Classical

Pancreaticoduodenectomy - Whipple’s procedure

Pylorus preserving

Pylorus preserving pancreaticoduodenectomy

Endoscopic endoprosthesis drainage (by ERCP)

Pancreatic cancerEndoscopic palliation