Carcinoma of pancreas is more common in middle aged people, and smokers are at a higher risk. Males are affected more. Pancreatic carcinomas tend to be solid schirrous adeno- carcinoma in majority of cases, but cystedenocarcinoma is also found. Head of pancreas is involved in 80% of cases, body and tail involvement contribute to the rest. Carcinomas affecting the tail of pancreas tend to grow to a large size before presenting with symptoms.
Clinical features : Carcinoma of pancreas does not give rise to any symptoms in the initial stages. There may be generalized weakness and weight loss up to 10% of body weight. The patient may develop vague pain in the epigastric region which radiates to the back. Common bile duct gets obstructed due to compression from the carcinoma in the head of pancreas, giving rise to obstructive jaundice. The gall bladder enlarges and is tense on palpation without tenderness. (Courvoisier's law). If the growth is in the body or tail of pancreas, the splenic vein may get infiltrated giving rise to congestive splenomegaly.
Diagnosis : Ultra sound and CT scans are the only modalities where the diagnosis of carcinoma of pancreas can be done with any certainty. ERCP may be useful in diagnosing obstruction to common bile duct.
Management : By the time clinical features occur, the growth usually becomes inoperable. Even then, surgical resection is the only treatment which may give some chances of cure, which is less than 5%. Cystedeno-carcinomas give a better prognosis. Symptomatic relief from obstructive jaundice can be obtained by passing a stent through the common bile duct opening. This can done at the time of ERCP.