Carcinoma pancrease attains largest size when it is sited in -
Some 90% of pancreatic neoplasms are adenocarcinomas that arise from the pancreatic ducts. These tumours involve local structures and metastasise to regional lymph nodes at an early stage. Most patients have advanced disease at the time of presentation. Neuro-endocrine tumours also arise in the pancreas but tend to grow more slowly and have a better prognosis; these are discussed in detail on page 678. Pancreatic adenocarcinoma affects 10-15 per 100 000 in Western populations, rising to 100 per 100 000 in those over the age of 70. Men are affected twice as often as women. The disease is associated with increasing age, smoking and chronic pancreatitis. Between 5% and 10% of patients have a genetic predisposition: hereditary pancreatitis, HNPCC and familial atypical mole multiple melanoma syndrome (FAMMM). Overall survival is only 3-5%, with a median survival of 6-10 months for those with locally advanced disease and 3-5 months if metastases are present. Clinical features Many patients are asymptomatic until an advanced stage, when they present with central abdominal pain, weight loss and obstructive jaundice . The pain results from invasion of the coeliac plexus and is characteristically incessant and gnawing. It often radiates from the upper abdomen through to the back and may be eased a little by bending forwards. Almost all patients lose weight and many are cachectic. Around 60% of tumours arise from the head of the pancreas, and involvement of the common bile duct results in the development of obstructive jaundice, often with severe pruritus. A few patients present with diarrhoea, vomiting from duodenal obstruction, diabetes mellitus, recurrent venous thrombosis, acute pancreatitis or depression.Physical examination reveals clear evidence of weight loss. An abdominal mass due to the tumour itself, a palpable gallbladder or hepatic metastasis is commonly found. A palpable gallbladder in a jaundiced patient is usually the consequence of distal biliary obstruction by a pancreatic cancer (Courvoisier's sign). Ref Davidson edition23rd pg842
Head
Ampulla
Body & tail
Periampullary
G.I.T