- Cigarette smoking is thought to be a significant risk factor
- Whipple's procedure, a radical surgery for pancreatic carcinoma, carries a risk of mortality of 20%
- Overall 5 year survival rate is 20%
- In approximately 80%, the carcinoma arises from the head
- Carinomas arising from the head carry worse prognosis than those arising from the body or tail
Answers: T, F, F, T, F
Regarding resectability of pancreatic adenocarcinoma, (***)
- Tumour size more than 3cm is likely to be unresectable
- Peripancreatic lymphadenoapthy is absolute contraindication for surgery
- The tumour is likely to be irresectible if the contiguity between tumour and major vessel is more than 50%
- Vascular occlusion makes the tumour irresectible
- Invasion of splenic vessels is absolute contraindication for surgery
Answers: T, F, T, T, F
Notes: Cigarette smoking is thought to account for 30% of deaths from pancreatic adenocarcinoma. Diabetes and chronic pancreatitis are also associated with increased risk of pancreatic adenocarcinoma. Whipple's procedure carries a risk of 5% mortality. The survival rate, including the ones undergone Whipple's, is not more than 5%. 80% of carcinomas arise from the head. The carconomas arising from body, tail and uncinate process carry worse prognosis than those arising from the head, because of late presentation.
Tumours more than 3cm are unlikely to be resectable. Peripancreatic lymphadenopathy is relative contraindication for surgery. Contuguity of 25-50% is equivocal for resectability, where as more than 50% makes it irresectable. Vascular encasement, occlusion or alterationin contour or caliber makes the tumour irresectable. Involvement of gastroduodenal, celiac or superior mesenteric artery is indicator of advanced disease, where as invasion of splenic vessels or spleen is not absolute contraindication for surgery.
