Painless Jaundice, Pruritus

Abstract

Of all the GI malignancies, pancreatic adenocarcinoma is the second most common cause of death from cancer. In general it is a malignancy of the elderly with vast majority of cases occurring after the age of 60. Due to usually advanced stage at the time of a diagnosis it remains a disease with very poor prognosis and high morbidity. Approximately two thirds of all pancreatic carcinomas occur within the head or neck of the pancreas. Pancreatic cancer is notoriously difficult to diagnose in its early stages. “Early” pancreatic cancer may be defined based on respectability, size or curability. Detecting resectable cancer is the first step in the fight against pancreatic cancer. “Early” pancreatic cancer defined as tumors ≤20 mm in size is also called “small” pancreatic cancer. The most stringent definition of “early” pancreatic cancer is that of curable pancreatic cancer. The classical direct tumour sign is the presence of a hypoattenuating/hypointense mass at contrast-enhanced MDCT or MRI. There are also six indirect tumour signs which should suggest the possibility of a pancreatic mass: the presence of (1) biliary duct dilatation, (2) pancreatic duct dilatation, or a (3) double duct sign, which may lead to (4) focal atrophy of the gland. If a mass is sufficiently large it will (5) distort the contour of the gland, and (6) loss of pancreatic lobulation.