The Diagnosis and Roentgen Treatment of Carcinoma of the Head of the Pancreas

Abstract

OF all the neoplasms which are observed to occur in the pancreas, carcinoma is by far the most frequent. Sites of predilection are, in the order named, the head, the body, and the tail of the organ. Vorhaus asserts that approximately two-thirds of all primary pancreatic carcinomas found surgically are located in the head. According to Ewing, tumors confined to the body of the organ are much less common. Scholz estimates the incidence of carcinoma of the tail of the pancreas at about 1.5 per cent of pancreatic carcinomas. Hoffman, in 1934, set the mortality from cancer of the pancreas at not less than 3 per cent of the total mortality from all forms of malignant diseases in the United States. Hoffman is of the opinion, therefore, that carcinoma of the pancreas can no longer be referred to as a rare disease. While there is occasional evidence to the effect that males are more often affected than females, apparently the disease displays no particular preference for either sex. As is true of most carcinomas, the disease is decidedly one of the late years of life. The cause and nature of carcinoma of the pancreas is still the subject of wide controversy. Hulst insists that cirrhosis constitutes a predisposing condition. Leriche characterizes cholelithiasis or pancreatic calculus as an occasional incidental factor of etiologic importance. Ewing, who bases his opinion upon analogy with the liver, believes that carcinoma of the pancreatic parenchyma has its inception in a functional hyperplasia following cirrhosis, and that carcinoma of the ducts results from chronic irritation and stasis in the same. Ewing also suggested that tumors might sometimes arise from aberrant glandular tissue. Horgan sought to establish a relationship between carcinoma arising in the islands of Langerhans and the chronic pancreatitis frequently found in case of peptic ulcer. In general, the prodromal stage of primary pancreatic carcinoma is mild, the disease usually manifesting itself at the outset in the guise of a gastro-intestinal affection, with subsequent marked signs of intestinal indigestion, pain, vomiting, emaciation, anemia, and progressive debility. When the tumor is located in the head, the classical Bard-Pic syndrome of profound, progressive, or painless jaundice, dilated and palpable gall bladder, and accelerated cachexia, with rapid emaciation and asthenia, makes its appearance in the majority of cases. Kiefer, who, in 1927, reported 27 cases of carcinoma of the pancreas out of a series of 33 cases of pancreatic malignancy observed and studied by him at the Peter Bent Brigham Hospital, enumerated the most common symptoms in their order of frequency, as cachexia (including loss of weight, anorexia, weakness, and anemia), jaundice, pain usually with or without vomiting, indigestion, and constipation.