Carcinoma of the pancreas, [s8]uncommon in most of the developing world

If a patient's carcinoma is in the head of his pancreas (70%), it obstructs his common bile duct, so that he presents with painless progressive obstructive jaundice (13.8). If it is in the body of his pancreas (30%), he presents with upper abdominal pain and general symptoms of malignancy. Spread to the lymphatics and surrounding structures is early, and 10% of patients develop ascites. Thrombophlebitis migrans (thrombophlebitis in any superficial vein appearing, resolving, and then appearing again elsewhere) may occur with any malignant tumour, but is particularly common with this tumour.

Radiotherapy, chemotherapy, and surgery are of little value. Pancreatico-duodenostomy has 5% of 5 year survivors in carcinoma of the head of the pancreas proper, and 20% if it is in the periampullary region. Surgery has a 20% mortality in the best hands.

CARCINOMA OF THE HEAD OF THE PANCREAS. If an experienced surgeon is within easy reach, refer the patient; but all he will be able to do is to establish the diagnosis and palliate him.

If you find carcinoma of the head of the pancreas during an exploratory laparotomy, a cholecystojejunostomy (13-5) is useful palliation, because it will relieve his jaundice (13.8).