45. Pancreatic cancers;

Definition:

• Pancreatic cancer is a malignant tumor of the pancreas, commonly originating from the ductal epithelium (most common type: adenocarcinoma). It is generally aggressive and has a poor prognosis.
• The tumors are often classified by their location:
• Head of the pancreas or Ampulla of Vater: Most common site.
• Body or Tail of the pancreas: Less common but still significant.
• Cystic Lesions: Most are pseudocysts, but true cystic neoplasms can include serous cystadenomas, mucinous cystadenomas, and intraductal papillary mucinous tumors (IPMTs), which have a higher risk of malignancy.

Risk Factors:

• Smoking: Strongest modifiable risk factor.
• Chronic pancreatitis: Increases risk, especially in the setting of long-term inflammation.
• Genetic predisposition: Includes mutations in BRCA1, BRCA2, and familial syndromes like Peutz-Jeghers syndrome.
• Environmental factors: Exposure to chemicals (e.g., petroleum) may increase risk.

Etiology:

• Smoking and chronic pancreatitis are the most established environmental risk factors.
• Genetic predisposition plays a role in certain familial syndromes.

Symptoms:

• Carcinoma of the head of the pancreas or ampulla of Vater:
• Early: Obstruction of the bile duct → jaundice (yellowing of skin and eyes), painless.

• Late: Progression may lead to obstruction and associated symptoms.
• Carcinoma of the body or tail of the pancreas:
• Dull abdominal pain radiating to the back.
• Non-specific symptoms: Anorexia, weight loss.
• Pain relief: Patients often feel better when sitting forward.