CARCINOMA OF

PANCREAS
BY-LAKSH BANSAL
ROLL NO-50
MODERATOR- DR AMIT KUMAR
Epidemiology
• 10th most common cancer .
•   4 th leading cause of cancer death. 
•  80% of cases are adenocarcinomas from exocrine pancreas 
     – Less common exocrine tumors include:
       • IPMN 
       • Mucinous cystadenocarcimomas
• Most common in black males 
• Median age of diagnosis is 70
Causes And Risk Factors
• Pancreatic cancer is fundamentally a disease caused by damage to the
DNA. This damage is often referred to as mutations.(Inheritance or
Carcinogens).
 • Smoking
 • Age, gender
 • Obesity , long standing diabetes
 • Diet – high fat, low fibre 
 • Chronic pancreatitis 
 • Family history – BRCA2 
 • Β-napthylamine
Sign & Symptoms
•   Jaundice- pruritic
•   Pain in the upper or middle abdomen and back
•   Unexplained weight loss 
•   Loss of appetite
•   Fatigue
•   Trousseau’s syndrome 
•   Clinical Depression
• Tumors in the head of the pancreas are more likely to have jaundice
• Those that arose in the body or tail, more likely pain and weight loss
Diagnostic Procedures
• Routine blood tests e.g. liver products like bilirubin
• Elevated tumor markers (CA 19-9 or CEA)
• MRI
•  CT scans with IV contrast
•  Ultrasound 
• Endoscopy including endoscopic ultrasound or ERCP
• Biopsy
Elevated CA 19-9
• Cancer 
   - Pancreas 
   - Biliary Cancer (gallbladder, cholangiocarcinoma, ampullary) 
   - Hepatocellular

• Benign 
   - Acute cholangitis 
   - Cirrhosis and other cholestatic diseases (gall stones)
CT SCAN 
Stages of pancreatic cancer
• Stage IA (T1aN0M0) - Tumour size –2cm
• Stage IB (T2N0M0) over 2cm, limited to pancreas
• Stage IIA (T3N0) beyond the pancreas
• Stage IIB (T1-3N1M0)
• Stage III (T4) Unresectable- Cancer has spread to the major blood
vessels near the pancreas
• Stage IV – Metastasis usually to lungs, liver and peritoneal cavity
SURGERY
• Surgery with the intention of a cure is only
possible in around one-fifth (20%) of new
cases.
• Whipple`s procedure-The Whipple
procedure (pancreaticoduodenectomy) is
an operation to remove the head of the
pancreas, the first part of the small intestine
(duodenum), the gallbladder and the bile
duct. The remaining organs are reattached
to allow you to digest food normally after
surgery.
•  total pancreatectomy 
• distal pancreatectomy
Prognosis
• Overall prognosis seems dismal
• 70-80% of patients present as inoperable due to metastatic disease
or locally advanced disease 
    – Median survival only 4-6 months 
•  20-30% are operable with localized or resectable locally advanced
disease 
•  Successful operation can give five year survivals from 20-30%
• A 65 year old gentleman presented with dull aching upper abdominal pain
radiating through to the back and worsened by eating. He had also noticed
yellow discoloration of his skin and had lost weight. In his past medical history,
he was diagnosed with diabetes mellitus 6 months earlier. A CT scan revealed a
localised mass lesion in the head of pancreas with biliary duct dilatation. All the
following are true except:

 1. CT guided biopsy is needed to confirm the diagnosis

 2. There is little evidence of benefit from routine biliary stenting of jaundiced

patients before resection.
 3. A diagnosis of pancreatic cancer should be considered in unexplained diabetes
(no family history, obesity or steroids) in patients over 50 years of age.
 4. Gastroduodenal artery encasement is not a contraindication for curative surgery
 5. Whipple’s operation is the standard operation for cancer of pancreatic head
 REFERENCES
BAILEY AND LOVE'S TEXTBOOK OF SURGERY