Clinical Review ABC of diseases of liver, pancreas, and biliary system

Pancreatic tumours

BMJ 2001; 322 doi: (Published 24 March 2001) Cite this as: BMJ 2001;322:721
  1. P C Bornman,
  2. I J Beckingham

    Neoplasms of the pancreas may originate from both exocrine and endocrine cells, and they vary from benign to highly malignant. Clinically, 90% of pancreatic tumours are malignant ductal adenocarcinomas, and most of this article concentrates on this disease.

    Types of pancreatic neoplasms

    • Benign exocrine

      Serous cyst adenoma

      Mucinous cyst adenoma

    • Malignant exocrine

      Ductal adenocarcinoma

      Mucinous cyst adenocarcinoma

    • Endocrine




    Ductal adenocarcinoma

    Incidence and prognosis

    Carcinoma of the pancreas has become more common in most Western countries over the past three decades, and although there is evidence of plateauing in some countries such as the United States, it still ranks as the sixth commonest cause of cancer death in the United Kingdom. Most patients are over the age of 60 years (80%) and many will have concurrent medical illnesses that complicate management decisions, particularly because the median survival from diagnosis is less than six months.

    Factors predicting poor prognosis

    • Back pain

    • Rapid weight loss

    • Poor performance status—for example, World Health Organization or Karnofsky scoring systems

    • Ascites and liver metastases

    • High C reactive protein and low albumin concentrations

    Clinical presentation

    Two thirds of pancreatic cancers develop in the head of the pancreas, and most patients present with progressive, obstructive jaundice with dark urine and pale stools. Pruritus, occurring as a result of biliary obstruction, is often troublesome and rarely responds to antihistamines. Back pain is a poor prognostic sign, often being associated with local invasion of tumours. Severe cachexia, as a result of increased energy expenditure mediated by the tumour, is also a poor prognostic indicator. Cachexia is the usual presenting symptom in patients with tumours of the body or tail of the pancreas.

    Rarer presentations of pancreatic carcinoma

    • Recurrent or atypical venous thromboses (thrombophlebitis migrans)

    • Acute pancreatitis

    • Late onset diabetes mellitus

    • Upper gastrointestinal bleeding


    The commonest sign is jaundice, with yellowing of the sclera and, once the bilirubin concentration exceeds 35 μmol/l, the skin. Many patients with high bilirubin …

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