1. Diseases of the Pancreas

2. 67 y old male with loss of appetite, gradual weight loss and dyspepsia. Recent onset of jaundice and dark urine.

3. Pancreatic cancer 4 th most common cancer-related death Mainly adenocarcinoma Persons 60-80 yrs 5 year survival < 4%

4. Pancreatic cancer Smoking Chronic pancreatitis Obesity Diabetes Family history Cystic lesions (IPMN/MCA) Risk factors:

5. Pancreatic intraepithelial neoplasia (PanIN 1-3)

6. Pancreatic adenoCa Head>whole gland>body>tail Lesions of head/ampulla > jaundice, Courvoisier’s gallbladder Often invade surrounding structures (inoperable)

7. Pancreatic cancer Anorexia, Weight loss Painless jaundice Chronic back pain Depression Thrombophlebitis Symptoms:

8. Pancreatic cancer Elevated serum CA 19-9 CEA Diabetes mellitus Laboratory findings:

9. Pancreatic cancer diagnosis US, CT, EUS, ERCP, MRI

10. CT

11. Endoscopic UltraSonography (EUS)

12. EUS + FNA

13. MRI

14. ERCP

15. Pancreatic cancer - treatment Surgical resection: Resectability determined by: 1) no metastases 2) no invasion of porta hepatis, portal vein behind body of pancreas, SMA region 3) no spread to liver or other peritoneal structures

16. Pancreatic cancer - surgical therapy Classical Pancreaticoduodenectomy - Whipple’s procedure Pylorus preserving

17. Pylorus preserving pancreaticoduodenectomy

18. Endoscopic endoprosthesis drainage (by ERCP) Pancreatic cancer Endoscopic palliation