Pancreatic Tumours
·
Weight loss, anorexia, lethargy
·
Pain
·
Jaundice (70%)
·
Pruritis (itching)
·
Diabetes mellitus
·
FBC: anaemia, sepsis
·
LFT: to confirm obstructive
jaundice
·
Ultrasound
·
ERCP or CT
·
Obstructive jaundice
·
Hepatic jaundice
·
Cachexia: gastric, colorectal or
ovarian cancer
·
Other pancreatic disease
·
Pseudocysts (don‟t have epithelial
lining so not a true cyst – not neoplastic):
o Congenital (rare) or acquired
o Solitary cyst 5 – 10 cm diameter, contains serous, turbid fluid
o Associated with pancreatitis
·
Benign tumours: rare. Serous cystadenoma (elderly women), solid
cystic tumour (young women)
·
Carcinoma of the pancreas
o Epidemiology:
§ 5% of cancer deaths
§ Usually fatal, 90% die within one year, 5 year survival 1 – 2%
§ Associated with smoking, fatty diet, chemical carcinogens
§ M > F, B > W, 60+
o Presentation:
§ Often perineural invasion (travels along nerves) ®
difficult pain
§ Affecting head: obstructive jaundice
§ Affecting tail: weight loss, liver metastases
o Macroscopic appearance: 60% head (most pancreatic tissue is there).
Grey-white tumour with infiltrative margins. Extends to duodenum, liver, nodes,
etc
o Microscopic appearance: 90% adenocarcinoma, 10% adenosquamous. Other rare types
o Treatment: palliative. Stenting
or ERCP for duct compression
o If resection possible:
§ For body/tail: distal pancreatectomy – usually need to remove spleen as
well
§ For head: pancreaticoduodenectomy (Whipple operation)
·
Other tumours: benign or
malignant endocrine tumours (insulinoma, gastrinoma)
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