• Marked weight loss, abdominal pain and jaundice are common presenting symptoms
• Pancreatic mass often visible on CT scan
• Biliary and duodenal obstruction from tumor growth may occur if located in the pancreatic head
• Incidence and mortality rates are roughly the same, underscoring the abysmal prognosis—5-year survival, < 3%
• Third leading cause of cancer in men between ages 35 and 54
• Risk factors include:
-Dietary consumption of meat (especially fried meat) and fat
-Previous gastrectomy (> 20 years earlier)
-Race (In the United States, but not in Africa, blacks are more susceptible than whites.)
• The peak incidence is in the fifth and sixth decades
• In 67% of cases, the tumor is located in the head of the gland; the remainder occurs in the body or tail
• Early local extension to contiguous structures; metastases to regional lymph nodes and the liver; and later, metastases to lungs, peritoneum, and distant lymph nodes
• Weight loss
• Abdominal pain
• Back pain (worse prognosis)
• Migratory thrombophlebitis
• Palpable epigastric mass
• Obstructive jaundice, often with pruritus and/or cholangitis
• Palpable, nontender gallbladder in the right upper quadrant (Courvoisier sign)
• Sudden onset of diabetes mellitus in 25% of patients
• Elevated alkaline phosphatase
• Elevated serum bilirubin
• Elevated serum levels of the tumor marker CA 19-9; sensitivity is too low to use as a screening tool
• CT scan
-In patients with a typical clinical history and a pancreatic mass on CT, ERCP is unnecessary
-Stenosis or obstruction of the pancreatic duct and/or bile duct ("double-duct sign")
• Upper GI series
• Tumors of the body and tail cause biliary and duodenal obstruction less commonly than tumors in the head
• Percutaneous aspiration of pancreatic mass risks tumor spread; contraindicated in surgical candidates
• CA 19-9 useful to follow the results of treatments; after complete resection, levels rise again with recurrence.
• CT findings suggesting unresectability:
• Chronic pancreatitis
• Other periampullary neoplasms:
• Retroperitoneal lymphoma
• Retroperitoneal sarcoma
• CT scan
• ERCP or endoscopic US if pancreatic cancer suspected but mass not visualized on CT scan
• If mass determined unresectable by CT scan, percutaneous or endoscopic US-guided needle aspiration for cytologic confirmation of diagnosis
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