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Adenocarcinoma of the Pancreas

Adenocarcinoma of the Pancreas. Prof. Faisal Ghani Siddiqui MBBS; FCPS; PGDip -biomedical ethics; MCPS-HPE. Epidemiology. 37,680 developed carcinoma pancreas 34,290 died of carcinoma pancreas. Epidemiology. 4 th l eading cause of cancer deaths (lung, colon, breast/prostate) 6%

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Adenocarcinoma of the Pancreas

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  1. Adenocarcinoma of the Pancreas Prof. Faisal Ghani Siddiqui MBBS; FCPS; PGDip-biomedical ethics; MCPS-HPE

  2. Epidemiology 37,680 developed carcinoma pancreas 34,290 died of carcinoma pancreas

  3. Epidemiology 4th leading cause of cancer deaths (lung, colon, breast/prostate) 6% of all cancer deaths

  4. Aetiology • Cigarette smoking • Smokeless tobacco • Chronic pancreatitis • Diabetes • Cirrhosis • Obesity

  5. Pathology • 5 – 6th decade • Head of the pancreas (75%); body & tail (25%) • Ductal adenocarcinoma (80%) • Islet cell carcinoma/cystadenoma

  6. Pathology • Extension to contiguous structures & organs • Regional lymph nodes / liver • Lungs, peritoneum & distant lymph nodes

  7. CLINICAL features

  8. Head of Pancreas • Jaundice • Weight loss • Pain • Hepatomegaly • Sudden onset diabetes • Palpable gallbladder • Migratory thrombophlebitis

  9. Armand Trousseau first described this finding in the 1860s

  10. Courvoisier’s Law -in the presence of a palpable gallbladder in the presence of jaundice, the cause is unlikely to be gallstones

  11. investigations

  12. Laboratory Investigations • Elevated bilirubin & alkaline phosphatase • Normal serum aminotransferase • Elevated CA 19-9

  13. CT Scan • Pancreatic mass (95%) • Dilated pancreatic duct (70%) • Dilated CBD (60%) • Signs of unresectability Contiguous organ invasion | involvement of superior mesenteric vessels or portal vein | distant metastases | Ascites

  14. ERCP • Stenosis of pancreatic duct Upper GI series • Widening of the duodenal sweep • Narrowing of the lumen • “reversed-3 sign” • Aspiration Biopsy

  15. Differential Diagnosis Periampullary carcinoma Ampulla of Vator Duodenum CBD

  16. Treatment

  17. Resectability • Hepatic artery near its origin • Superior mesenteric artery • Regional lymph nodes • Liver

  18. Pancreatoduodenectomy(Whipple’s procedure)

  19. Palliation for Pancreatic Cancer • Cholecystojejunostomy • Choledochoduodenostomy • Stents • Chemotherapy

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