Updates in the Management of Malignant Pancreatic Neoplasms

Abstract

The pancreas is a retroperitoneal organ and does not have a capsule. The second and third portions of the duodenum curve around the head of the pancreas. The spleen is adjacent to the pancreatic tail. The regions of the pancreas are the head, body, tail and uncinate process The exocrine cells and endocrine cells of the pancreas form completely different types of tumors. Exocrine tumors are by far the most common type of pancreas cancer. About 95% of cancers of the exocrine pancreas are adenocarcinomas. Major problem is early detection since 80–90% of pancreatic cancers are locally or systemically advanced at the time of diagnosis. However, in patients who are suitable for resection, five-year survival rates of 25% are possible which underlines that surgery offers the only chance of cure and long-term survival. The initial clinical presentation of pancreatic adenocarcinoma typically varies according to tumor location. Two-thirds of pancreatic adenocarcinoma occurs in the head of the pancreas, with the remaining one-third occurring in the body and tail. Clinical presentations of pancreatic neoplasms may include: right–upper quadrant or epigastric pain, jaundice, nausea or vomiting secondary to obstruction of the gastric outlet, diarrhea and steatorrhea due to pancreatic insufficiency, new onset or worsening of previously stable diabetes, back pain. Systemic manifestations may include profound and rapid weight loss, anorexia, and thromboembolic disease Management of pancreatic ductal adenocarcinoma (PDAC) is an interdisciplinary challenge, as this tumor entity is still characterized by a poor prognosis, with long-term survival of only 1–5%. From the oncological perspective, pancreatic cancer represents the fourth leading cause for cancer related mortality in the Western world with more than 100,000 deaths in Europe and the USA per year. Diagnosis is often made on the basis of the patient’s history of illness as well as imaging studies. Diagnostic imaging plays a crucial role in the management of pancreatic ductal adenocarcinoma, there are non invasive imagings such as: US, PET/CT, MRI, MDC, MRCP, and invasive imaging such as: Intraoperative ultrasound (IOUS), Intraductal ultrasound (IDUS), ERCP, Percutaneous transhepatic cholangiography (PTC).