Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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 +++ Epidemiology + • 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: -Cigarette smoking-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 +++ Symptoms and Signs + • Weight loss• Abdominal pain• Back pain (worse prognosis)• Nausea/vomiting• 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 +++ Laboratory Findings + • 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 +++ Imaging Findings + • CT scan-Pancreatic mass-Dilated pancreatic duct and/or bile duct-Allows determination of resectability in most cases• ERCP-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-Determines patency of the duodenum-Useful in deciding whether a gastrojejunostomy will have to be performed + • 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:-Local tumor extension-Contiguous organ invasion-Distant metastases-Involvement of the superior mesenteric or portal vessels-Ascites +++ Rule Out + • Chronic pancreatitis• Other periampullary neoplasms:-Carcinoma of the ampulla of Vater, distal common bile duct, or duodenum• 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 +++ When to Admit + ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.