Pancreatic Carcinoma
(Gastroenterology 1999;117:1463-84)
DEFINITION:
Adenocarcinoma, well-differentiated, arising from pancreatic ductal epithelium (90% of cases)
Most arise in the head of pancreas (80%)
See also Pancreas/Biliary- Cystic Disease of the Pancreas (Chapter 5.04)
EPIDEMIOLOGY:
30,000 new cases a year
85% have distant metastases at diagnosis
ETIOLOGIES:
Risk factors: smoking & working in chemical industry (aromatic amines), chronic pancreatitis, diets large in fats and meat products
Risks may also include Diabetes Mellitus, pernicious anemia, partial gastrectomy; ETOH has not been shown to be a proven risk
Hereditary pancreatitis is a risk, but is probably more related to chronic pancreatitis
Intraductal Papillary Mucinous Neoplasm (IPMN) are a risk factor, See also Pancreas/Biliary- Cystic Disease of Pancreas (Chapter 5.04)
Inheritance: 6-8% of patients have a family history in a first-degree relative, representing a 13-fold increase
Syndromes associated with increased risk: Peutz-Jeghers syndrome, BRCA2 mutations (most common inheritance risk)
Protective: high intake of dietary fiber
PATHOPHYSIOLOGY:
About 80% of pancreatic ductal adenocarcinomas occur in the head of the pancreas
Histology varies from: well-differentiated with glandular structures to poorly differentiated that exhibit little or no glandular structure or stroma
Metastases to liver and lungs; can also spread to adrenals, kidneys, bone, brain, and skin
CLINICAL MANIFESTATIONS/PHYSICAL EXAM:
Abdominal pain (80% of patients), jaundice (50% of patients)
Weight loss (with or without anorexia and usually without steatorrhea) and early satiety
If pancreatic head cancer, then obstruction of distal CBD with development of obstructive jaundice
Courvoisier’s sign: palpable, distended gallbladder in RUQ and jaundice
Usually result of malignant bile duct obstruction: pancreatic, cholangiocarcinoma or ampullary mass (not specific for cancer)
Abdominal pain with radiation to back, weight loss, nausea, anorexia
LABORATORY STUDIES:
CA19-9: sensitive >90%, specificity 75%; Often normal in early stages and small tumors (<1 cm)Related posts:
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