Pancreas and Duodenum

Abstract

Primary epithelial neoplasms of the pancreas can be divided into those of exocrine and endocrine origin. Nonepithelial and secondary pancreatic neoplasms are uncommon, and will not be covered in this chapter. Surgical therapy may be appropriate for some of these tumors, depending on the clinical situation, and the principles outlined for primary neoplasms can usually be followed.

Pancreatic exocrine neoplasms are relatively common, with adenocarcinoma accounting for most cases. Early signs and symptoms of pancreatic exocrine tumors vary with tumor location, and are usually vague and nonspecific (e.g., anorexia, malaise, abdominal pain, and weight loss), often resulting in slower diagnosis. Adeno-carcinomas of the pancreatic head are more likely to be resectable at diagnosis than body and tail lesions, as they often cause biliary obstruction and jaundice. In general, pancreatic adenocarcinoma is a rapidly progressive and lethal cancer.

Pancreatic endocrine neoplasms (PEN) are encountered less frequently, and vary considerably in presentation and prognosis. Patients with these tumors may be asymptomatic; they may exhibit nonspecific symptoms such as pain or weight loss; or they may manifest recognizable signs and symptoms of clearly defined syndromes. Examples include insulinoma and carcinoid tumors. Malignancy is often defined by tumor behavior and histology. In general, surgical resection is the mainstay of therapy for PENs. It may be appropriate to surgically remove PENs despite the presence of metastatic disease, given the relative chronic nature of these tumors.