Tumors of the exocrine pancreas:
Generally poor prognosis.

  • 10% of digestive cancers.
  • Average age of onset.
  • 70 years for women.
  • 65 for men.
  • Promoting role of smoking and chronic pancreatic.

Pathologists:

  • 2 / 3: head of the pancreas.
  • 1 / 3: tail of the pancreas.
  • Rapid expansion in loco regional lymph nodes.
  • Adenocarcinoma.

Clinic.

  • Late discovery as long clinically silent
  • Cancer of the head: cholestatic jaundice.
  • Cancer of the body and tail:
    • Epigastric pain type transfixing
    • Impaired general condition.
    • Sometimes palpable epigastric mass

Imaging.

  • The ultrasound examination remains the first line, revealing a poorly defined hypo echoic mass, and to highlight liver metastases. As cites may also be disclosed and demonstrate a peritoneal carcinomas.
  • The echo-endoscopy is useful in diagnosing small tumors.
  • Scanner.
  • ERCP.




Biology:

  • Markers:
    • Ace: sensitivity 30 to 40%.
    • CA 19-9, however, its sensitivity is low, especially in cases of small tumor. There is sometimes a more significant elevation of CA 19-9 in cases of simple cholestasis

Treatment.

  • Excision: only treatment giving a greater chance of survival but is possible only in a limited number of cases with a significant risk of relapse.
  • Cure:
    • Pancreatectomy.
    • Splenopancreatectomie left.
    • Extended or regional.
    • Total.


  • Palliative treatment:
    • Deviation bilio-digestive anastomosis between the gallbladder bile duct and duodenum.
    • Deviation digestive: gastro-jejunostomy.
    • Prosthetics biliaire.dpc
  • Results of surgical treatment:
    • Duodena-cephalic pancreatectomy: 5-year survival = 20% for complete resection. 1 to 4% survival at 5 years from the diagnosis
    • Palliative: survival <1 year.
  • Other treatments:
    • Palliative treatment: radiotherapy, chemotherapy.
    • Adjuvant treatment: radiotherapy + chemotherapy after complete resection.

The pancreatic endocrine tumors:
Less than 10% of all pancreatic tumors.
They develop from:

  • Cells of islets of Langerhans = pancreatic endocrine cells normally present.
  • Cells normally missing from the endocrine pancreas after a few weeks of life of the newborn.
  • Benign or malignant.