Pancreatic tumors

Pancreatic tumors can be benign or malignant and are categorized as adenocarcinoma, neuroendocrine tumors, and cystic neoplasm.

Pancreatic adenocarcinoma
Pancreatic adenocarcinoma are the most common tumor of the pancreas, risk factors are

  • Cigarette smoking
  • Tobacco chewing
  • Genetic mutations
  • Chronic pancreatitis

Symptoms of pancreatic cancer are

  • Pain in upper abdomen
  • Jaundice
  • Loss of appetite
  • Weight loss

Diagnosis
Following tests are required in a patient with suspected adenocarcinoma

  • Ultrasonography abdomen
  • CT scan
  • Diagnosis is confirmed by endoscopic ultrasound and fine needle aspiration

Treatment

  • Best available treatment is surgical resection.
  • However only 20 % of tumors are usually resectable
  • In the rest of cases treatment options are chemotherapy and palliation with stent placement in common bile duct and duodenum for relief of jaundice and vomiting respectively

Neuroendocrine tumors
Neuroendocrine tumors arise from islet cells and are classified as

  • Insulinoma
  • Gastrinoma
  • Somatostatinoma
  • VIPoma
  • Non Functional tumor

Symptoms of neuroendocrine tumor depend upon the type of tumor, and secreted hormones.
Common symptoms are

  • Diarrhea
  • Recurrent ulcer formation
  • Attacks of hypoglycemia

Treatment

  • Primary treatment of neuroendocrine tumor is surgery
  • Chemotherapy and somatostatin analogues are useful in metastatic diseases

Cystic neoplasm
Cystic neoplasm are usually detected incidentally, and has to be differentiated from pseuodcysts Most common type of cystic neoplasm are

  • Serous cystadenoma
  • Mucinous cystadenoma
  • IPMN (Intraductal papillary mucinous neoplasm)
  • Solid pseudopapillary neoplasm

Symptoms

  • Small lesion are usually asymptomatic and detected incidentally on imaging
  • Large lesions can lead to pain/jaundice

Diagnosis
Following tests are required in a patient with suspected cystic neoplasm

  • EUS is the test of choice for diagnosis and differentiation
  • During EUS, cyst fluid can be aspirated for analysis
  • Ultrasonography abdomen
  • CT scan of abdomen
  • Diagnosis is confirmed by endoscopic ultrasound and fine needle aspiration

Treatment

  • Small asymptomatic lesions can be followed up
  • Large or symptomatic lesions should be resected

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