ABC of diseases of liver, pancreas, and biliary system: Pancreatic tumours
BMJ 2001; 322 doi: https://doi.org/10.1136/sbmj.0105149 (Published 01 May 2001) Cite this as: BMJ 2001;322:0105149
- P C Bornman, professor of surgery1,
- I J Beckingham, consultant hepatobiliary and laparoscopic surgeon2
- 1University of Cape Town, South Africa
- 2department of surgery, Queen's Medical Centre, Nottingham
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.
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.
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. Examination
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 concentrations will have skin scratches associated with pruritus. Patients with advanced disease have severe weight loss accompanied by muscle wasting and occasionally an enlarged supraclavicular lymph node. A palpable gall bladder suggests pancreatic malignancy, but it can be difficult to detect when displaced laterally or covered by an enlarged liver. The presence of ascites or a …
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