Carcinoma of the pancreas

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CARCINOMA of the pancreas constitutes from 3.6 to 4.1 percent of all malignant disease in the general population.1 The early diagnosis of neoplastic lesions of the pancreas seems just as difficult today as it was in 1933 when so described by Rigler.2 The retroperitoneal location of the pancreas renders physical examination and radiologic procedures ineffective in determining the size and state of the pancreas. Thus, of necessity, various diagnostic criteria are directed toward detection of change in the viscera close to the pancreas. Clinical features suggestive of neoplasm of the pancreas may be so diverse and nonspecific, or late in developing, that the clinician cannot rely on them as a basis for early diagnosis. Further, to delay the diagnosis till the pathognomonic signs of the disease—pain, loss of weight, and jaundice—appear, seriously jeopardizes even a remote chance of the patient’s survival. In every suspected case, even laporotomy might not be diagnostic, and is certainly not the most desirable or practical approach. The five-year surgical “cure rate” is so low in regard to pancreatic cancer that the prognosis in most cases has not been altered by delayed operative treatment.

Diagnosis is relatively easy in regard to some of the functioning neoplasms, such as ulcerogenic tumor of the pancreas, and carcinoma of the β-islet cells of the pancreas. Tumors causing hypercalcemia,3, 4 carcinoid-like syndrome,5 and refractory diarrhea leading to hypokalemia4, 6 have also been reported but they occur infrequently. The hormonal effects of these tumors may precede manifestations resulting from. . .



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