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PERIAMPULLARY TUMORS

PERIAMPULLARY TUMORS. Prof. ÖZCAN GÖKÇE, MD Director of the Department of General Surgery Yeditepe University Hospital. Neoplasms of the Endocrine Pancreas. INSULINOMA GASTRINOMA VIPoma GLUCAGONOMA SOMATOSTATINOMA NONFUNCTIONING ISLET CELL TUMORS.

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PERIAMPULLARY TUMORS

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  1. PERIAMPULLARY TUMORS Prof. ÖZCAN GÖKÇE, MD Director of the Department of General Surgery Yeditepe University Hospital

  2. Neoplasms of the Endocrine Pancreas • INSULINOMA • GASTRINOMA • VIPoma • GLUCAGONOMA • SOMATOSTATINOMA • NONFUNCTIONING ISLET CELL TUMORS

  3. Passaro's triangle (The typical location of a gastrinoma)

  4. Radiolabeled octreotide scan

  5. Insulinoma Whipple’s triad • 1)Hypoglisemic symptoms by fasting • 2)Episodic low blood sugar(below 50 mg/dl) • 3)Relief of symptoms by glucose

  6. Treatment • Surgery • Diazoxide • Streptozotocin

  7. GASTRINOMA • (Zollinger-Ellison Syndrome) • Symptoms Ulcers and diarrhea Treatment Surgery Acid blocking agents Streptozotocin-5FU

  8. VIPoma • Verner-Morrison Syndrome…WDHA • Watery diarrhea • Hypokalemia • Achlorhydria • Pancreatic Cholera

  9. Treatment • Surgery • Streptozotocin • 5FU • Steroids • Trifluoperazine • Somatostatin

  10. MULTIPL ENDOCRINE NEOPLASIA • MEN I….3-P(Pituiatary,parathyroid,pancreas) Autosomal dominant(11q13 coded gene) • MEN IIA...(Pheo-Medullary tc-parathyroid tm) • MEN IIB..(Pheo-Medullary tc-ganglioneuromas) Mutation in ret proto-oncogene

  11. Neoplasms of the Exocrine Pancreas

  12. PERIAMPULLARY EPITHELIAL TUMORS 1)PANCREATIC CANCER 2)CANCER OF COMMON BILE DUCT 3)CANCER OF DUODENUM 4)TUMOR OF AMPULLA OF WATER 5)BENIGN TUMORS OF THE REGION(EXTREMELY RARE)…cystadenomas

  13. Pancreatic cancer is one of the most serious types of cancer occurring. It is a disease which forms malignant or cancerous cells in the tissues of the pancreas.

  14. The digestive juices are produced by exocrine pancreas cells and the hormones are produced by endocrine pancreas cells. About 95% of pancreatic cancers begin in exocrine cells.

  15. Pancreatic Cancer has been called a "silent" disease because early Pancreatic Cancer usually does not cause symptoms.

  16. If the tumor blocks the common bile duct and bile cannot pass into the digestive system, the skin and the sclera may become yellow (jaundiced), and the urine darker as a result of accumulated bile pigment called bilirubin.

  17. Pancreatic Cancer Causes • The exact as to what damages DNA in the vast majority of cases of pancreatic cancer is not clear. In other words the exact pancreatic cancer causes are not clear. But it is known that a small percentage of people develop the disease as a result of a genetic predisposition. These people who have a close relative, such as a parent or sibling, with pancreatic cancer have a higher risk of developing pancreatic cancer themselves.

  18. A number of genetic diseases have been associated with an increased risk of pancreatic cancer, including familial adenomatous polyposis, nonpolyposis colon cancer, familial breast cancer associated with the BRCA2 gene, hereditary pancreatitis, and familial atypical multiple mole-melanoma syndrome which is a serious type of skin cancer. This means that people who have a hereditary predisposition to develop these cancers are also more likely to develop pancreatic cancer.

  19. Although the above causes are evident only 10 percent of pancreatic cancers result from an inherited tendency. A greater number are caused by environmental or lifestyle factors, such as smoking, diet and chemical exposure.

  20. Age: is also a factor to be considered which increases the incidence of the disease. As age increases the probability of pancreatic cancer also increases. The incidence of Pancreatic Cancer is relatively low in individuals up to age 50, after which it increases significantly. The age group 65 - 79 has the highest incidence of Pancreatic Cancer.

  21. Smoking increases the chances of developing Pancreatic Cancer. Study reveals that smokers develop Pancreatic Cancer more than twice as often as nonsmokers.

  22. Non vegetarians have a high risk of getting Pancreatic Cancer, if the intakes of meat & fat are high.

  23. Medical factors such as cirrhosis (a chronic liver disease), chronic pancreatitis, diabetes and a history of surgery to the upper digestive tract also contribute to the risk

  24. Environmental factors such as long-term exposure to certain chemicals, like gasoline and related compounds, as well as certain insecticides, may increase the risk of developing Pancreatic Cancer.

  25. Genetic predisposition should also be considered as the possible reason to increase the risk. Possibly 10% of cases of Pancreatic Cancer are related to genetic disorders.

  26. Pancreatic Cancer Stage • To apt for any treatment option the doctor has to know the exact stage of the pancreatic cancer in the patient. Tests and procedures to stage pancreatic cancer are usually done at the same time as diagnosis. • The following are pancreatic cancer stage descriptions:

  27. Stage 0: In this stage the cancer is found only in the lining of the pancreas. Stage 0 is also called carcinoma in situ.

  28. Stage I: Cancer is found only in the pancreas in this stage. This stage further divided into stage IA and stage IB, based on the size of the tumor. • Stage IA: The tumor is 2 centimeters or smaller. • Stage IB: The tumor is larger than 2 centimeters.

  29. Stage II: Cancer may have spread to nearby tissue and organs, and may have spread to lymph nodes near the pancreas in this stage. This stage is further divided into stage IIA and stage IIB, based on where the cancer has spread. • Stage IIA: Cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes. • Stage IIB: Cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs.

  30. Stage III: Cancer has spread to the major blood vessels near the pancreas and may have spread to nearby lymph nodes in this stage.(Beyond this point the patient is surgically incurable)

  31. Stage IV: Cancer may be of any size and has spread to distant organs, such as the liver, lung, and peritoneal cavity. It may have also spread to organs and tissues near the pancreas or to lymph nodes.

  32. Pancreatic Cancer Symptoms • Discomfort in abdomen or Upper abdominal pain that may radiate to the middle or upper back • Yellowing of the skin and the sclera (jaundice) • Itching • Nausea and vomiting • Digestive problems • Weight loss • Fatigue • Loss of appetite • Glucose intolerance • Malnutrition.

  33. In addition, the pancreas may produce too much insulin, causing such symptoms as dizziness, weakness, diarrhea, chills, or muscle spasms.

  34. The patient may not even notice the gradual onset of these relatively nonspecific symptoms. The doctor may interpret them as being caused by something else. Therefore one should be very careful if any of the above symptoms are experienced.

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