Risk factors
Cigarette
Diabetes mellitus, Obesity
Heavy alcohol consumption (light to moderate consumption is not a risk factor)
chronic pancreatitis
Neoplastic pancreatic cysts (especially mucinous cysts)
Hereditary syndromes
- Hereditary pancreatitis (PRSSl)
- Familial breast/ovarian cancer (BRCA2, PALB2)
- Family! atypical multiple mole melanoma (P16/CDKN2A)
- Peutz - Jeghers syndrome (STKll/LKBl) (the syndrome that increases the risk most)
- Lynch syndrome (MLHl, MSH2)
- Ataxia telangiectasia (ATM)
Genetic changes: K-ras, p16, p53, SMAD4
Pathology
• The most common type is ductal adenocarcinoma.
• The tumor is 80% localized per pancreas.
Clinic
• Weight loss and abdominal pain are the most common symptoms.
• Jaundice is common in pancreatic head tumors.
• Courvoisier sign (palpable gallbladder on deep inspiration) may be present.
• Glucose intolerance, migratory thrombophlebitis (Trousseau syndrome) may be seen.
Diagnosis and treatment
• The first imaging method for diagnosis is abdominal USG.
• Spiral CT is one of the methods recommended after USG with a high diagnostic value (90%). Alternatively, it can be used in MR/MRCP and has diagnostic value like CT.
• Endoscopic USG is the most sensitive imaging method in diagnosis and allows safe biopsy in suspicious cases.
Endoscopic USG is also the most useful test in staging and in demonstrating portal vein involvement and lymph node involvement.
• CEA and CA-19-9 are tumor markers in pancreatic cancer. They are used for follow-up rather than diagnosis.
• In cases where tumor probability is high with imaging methods and surgically resectable, biopsy is not taken and the patient goes directly to laparotomy (Whipple operation). The reason for this is to prevent a possible spread during the biopsy.
• In cases that are suspicious or require histopathological diagnosis, a definitive diagnosis is made by fine-needle aspiration biopsy from the lesion with EUS.
Cigarette
Diabetes mellitus, Obesity
Heavy alcohol consumption (light to moderate consumption is not a risk factor)
chronic pancreatitis
Neoplastic pancreatic cysts (especially mucinous cysts)
Hereditary syndromes
- Hereditary pancreatitis (PRSSl)
- Familial breast/ovarian cancer (BRCA2, PALB2)
- Family! atypical multiple mole melanoma (P16/CDKN2A)
- Peutz - Jeghers syndrome (STKll/LKBl) (the syndrome that increases the risk most)
- Lynch syndrome (MLHl, MSH2)
- Ataxia telangiectasia (ATM)
Genetic changes: K-ras, p16, p53, SMAD4
Pathology
• The most common type is ductal adenocarcinoma.
• The tumor is 80% localized per pancreas.
Clinic
• Weight loss and abdominal pain are the most common symptoms.
• Jaundice is common in pancreatic head tumors.
• Courvoisier sign (palpable gallbladder on deep inspiration) may be present.
• Glucose intolerance, migratory thrombophlebitis (Trousseau syndrome) may be seen.
Diagnosis and treatment
• The first imaging method for diagnosis is abdominal USG.
• Spiral CT is one of the methods recommended after USG with a high diagnostic value (90%). Alternatively, it can be used in MR/MRCP and has diagnostic value like CT.
• Endoscopic USG is the most sensitive imaging method in diagnosis and allows safe biopsy in suspicious cases.
Endoscopic USG is also the most useful test in staging and in demonstrating portal vein involvement and lymph node involvement.
• CEA and CA-19-9 are tumor markers in pancreatic cancer. They are used for follow-up rather than diagnosis.
• In cases where tumor probability is high with imaging methods and surgically resectable, biopsy is not taken and the patient goes directly to laparotomy (Whipple operation). The reason for this is to prevent a possible spread during the biopsy.
• In cases that are suspicious or require histopathological diagnosis, a definitive diagnosis is made by fine-needle aspiration biopsy from the lesion with EUS.