Patient will present as → a 68-year-old smoker with a 25 lb weight loss over the last three months that is associated with a burning pain deep in the epigastrium after eating, diarrhea, and jaundice. Physical exam reveals a palpable non-tender gallbladder and clay-colored stool. Labs show a total bilirubin of 8, alkaline phosphatase of 450, and an ALT of 150.
Most common is ductal adenocarcinoma usually at the head of the pancreas
- Abdominal pain, jaundice, enlarged palpable gallbladder in 40% of patients (Courvoisier's sign), light-colored stools, dark urine, pruritus, weight loss
- Associated with cigarette smoking, pancreatitis, diabetes mellitus and obesity
Virchow's node (or signal node) is a lymph node in the left supraclavicular fossa (the area above the left clavicle).
- It takes its supply from lymph vessels in the abdominal cavity. Virchow's node is also sometimes coined “the seat of the devil” given its ominous association with malignant disease
"Pain of pancreatic cancer is often lessened by sitting and leaning forward (just like pancreatitis). This indicated that the lesion has spread beyond the pancreas and is inoperable."
Risk factors: smoking, alcohol, obesity and chronic pancreatitis.
Diagnose with abdominal CT scan - 75% show tumor at the head of the pancreas, 20% in body and 10% in the tail
- Increased amylase (if tumor obstructs ducts)
- Increased direct bilirubin
- Increased CEA
- Glucose intolerance
- ERCP - stenosis or obstruction of pancreatic ducts
- Tumor Marker: CA 19-9 - not diagnostic but can be used to follow response to therapy
Treatment is whipple procedure: remove antrum of stomach, part of duodenum, head of pancreas, gall bladder.
- Poor prognosis 2-5% five year survival
Gastric cancer cannot cause pruritus and enlargement of the gallbladder.
Gastric ulcer doesn’t present as jaundice and pruritus.
Hepatocellular carcinoma does not cause enlargement of the gallbladder.
magnetic resonance imaging scan of the abdomen
dual-phase helical computed tomography (CT) scan of the abdomen
high fat intake
previous exposure to radiation
Pancreaticoduodenectomy (Whipple procedure)
None of the above
Pancreatic carcinoma is the 5th leading cause of cancer death in US.
Men are affected twice as often as women.
75% occur in the tail.
May be associated with depression.