Diseases of the Pancreas

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Diseases of the Pancreas
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67 y old male with loss of appetite, gradual
weight loss and dyspepsia. Recent onset of
jaundice and dark urine.
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Pancreatic cancer

• 4th most common cancer-related death
• Mainly adenocarcinoma
• Persons 60-80 yrs
• 5 year survival lt 4

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Pancreatic cancer
Risk factors

• Smoking
• Chronic pancreatitis
• Obesity
• Diabetes
• Family history
• Cystic lesions (IPMN/MCA)

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Pancreatic intraepithelial neoplasia (PanIN 1-3)
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Pancreatic adenoCa

• Headgtwhole glandgtbodygttail
• Lesions of head/ampulla gt jaundice,
  Courvoisiers gallbladder
• Often invade surrounding structures
  (inoperable)

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Pancreatic cancer
Symptoms

• Anorexia, Weight loss
• Painless jaundice
• Chronic back pain
• Depression
• Thrombophlebitis

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Pancreatic cancer
Laboratory findings

• Elevated serum CA 19-9
• CEA
• Diabetes mellitus

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Pancreatic cancer
diagnosis
US, CT, EUS, ERCP, MRI
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CT
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Endoscopic UltraSonography (EUS)
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EUS FNA
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MRI
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ERCP
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Pancreatic cancer - treatment
Surgical resection
Resectability determined by 1) no metastases 2)
no invasion of porta hepatis, portal vein behind
body of pancreas, SMA region 3) no spread to
liver or other peritoneal structures
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Pancreatic cancer - surgical therapy
Pancreaticoduodenectomy - Whipples procedure
Classical
Pylorus preserving
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Pylorus preserving pancreaticoduodenectomy
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Pancreatic cancer
Endoscopic palliation
Endoscopic endoprosthesis drainage (by ERCP)