1) The document discusses pancreatic neoplasms, including classification into exocrine and endocrine tumors.
2) It highlights adenocarcinoma of the pancreas, noting risk factors like smoking, chronic pancreatitis, genetics, and more.
3) Diagnosis involves imaging like CT/MRI, blood tests, and pathology examination of biopsies showing malignant cells and fibrosis.
A 45-year-old female presented with recurrent vomiting, loss of appetite, abdominal pain, and significant weight loss over 6 months. Imaging revealed a 7x5cm cystic lesion in the pancreatic head and neck. The differential diagnosis for cystic pancreatic lesions includes pseudocyst, serous cystadenoma, mucinous cystic neoplasm, intraductal papillary mucinous neoplasm, and rarer entities. Specific imaging features, cyst fluid analysis, and clinical characteristics can help differentiate these potential diagnoses to guide management of the patient's cystic pancreatic lesion.
1) Carcinoma of the rectum arises from the adenoma-carcinoma sequence and risk factors include red meat, alcohol, smoking, and inflammatory bowel disease.
2) Evaluation involves digital rectal exam, rigid proctoscopy, colonoscopy, CT, MRI, and lab tests to stage the tumor and check for metastases.
3) Treatment depends on tumor stage but commonly includes total mesorectal excision surgery with clear margins and may involve radiation or chemoradiation to downstage the tumor preoperatively.
The document discusses carcinoma of the pancreas. It covers the anatomy, epidemiology, risk factors, genetics, screening, staging, pathologic conditions, clinical presentation, evaluation, management approaches for resectable, borderline resectable, and unresectable disease, surgical procedures including Whipple procedure and distal pancreatectomy, complications, adjuvant therapy approaches studied in trials such as ESPAC-1, and the role of chemoradiation following gemcitabine chemotherapy.
Gastrointestinal stromal tumors (GISTs) are rare sarcomas that arise from the gastrointestinal tract. Most commonly found in the stomach, they represent 0.2% of gastrointestinal tumors. While often asymptomatic, they can present with bleeding, pain, or obstruction. Diagnosis involves imaging such as endoscopy or CT scan followed by biopsy showing immunohistochemistry positive for CD117 in 95% of cases. Treatment involves surgical resection with clear margins although adjuvant therapy with imatinib is often used for higher risk tumors. Outcomes have improved greatly in the past two decades with 5-year survival rates now over 50% with appropriate treatment.
This document provides information on the management of soft tissue sarcoma. It discusses the clinical presentation, patterns of spread, imaging, histology, grading, staging, prognostic factors and management of soft tissue sarcomas. The key points are:
1) Soft tissue sarcomas most commonly present as painless swellings in the extremities and can invade locally along fascial planes. Imaging like MRI is important for assessing tumor extent.
2) Histologically, the most common subtypes are undifferentiated pleomorphic sarcoma and liposarcoma. Grading systems consider tumor differentiation, mitosis and necrosis.
3) Staging is based on tumor size, depth, nodal status and metastasis
This document provides an overview of carcinoma of the esophagus, including epidemiology, etiology, classification, diagnosis, staging, and management. It discusses the different types of esophageal cancer, risk factors, pre-malignant conditions, patterns of spread, diagnostic tools such as endoscopy and imaging, and the AJCC staging system. Treatment options are covered for early stage disease including endoscopic resection and ablation methods, as well as surgical approaches for localized and advanced disease, including transhiatal esophagectomy, Ivor-Lewis esophagectomy, and McKeown esophagectomy. Post-operative complications are also reviewed.
A 45-year-old female presented with recurrent vomiting, loss of appetite, abdominal pain, and significant weight loss over 6 months. Imaging revealed a 7x5cm cystic lesion in the pancreatic head and neck. The differential diagnosis for cystic pancreatic lesions includes pseudocyst, serous cystadenoma, mucinous cystic neoplasm, intraductal papillary mucinous neoplasm, and rarer entities. Specific imaging features, cyst fluid analysis, and clinical characteristics can help differentiate these potential diagnoses to guide management of the patient's cystic pancreatic lesion.
1) Carcinoma of the rectum arises from the adenoma-carcinoma sequence and risk factors include red meat, alcohol, smoking, and inflammatory bowel disease.
2) Evaluation involves digital rectal exam, rigid proctoscopy, colonoscopy, CT, MRI, and lab tests to stage the tumor and check for metastases.
3) Treatment depends on tumor stage but commonly includes total mesorectal excision surgery with clear margins and may involve radiation or chemoradiation to downstage the tumor preoperatively.
The document discusses carcinoma of the pancreas. It covers the anatomy, epidemiology, risk factors, genetics, screening, staging, pathologic conditions, clinical presentation, evaluation, management approaches for resectable, borderline resectable, and unresectable disease, surgical procedures including Whipple procedure and distal pancreatectomy, complications, adjuvant therapy approaches studied in trials such as ESPAC-1, and the role of chemoradiation following gemcitabine chemotherapy.
Gastrointestinal stromal tumors (GISTs) are rare sarcomas that arise from the gastrointestinal tract. Most commonly found in the stomach, they represent 0.2% of gastrointestinal tumors. While often asymptomatic, they can present with bleeding, pain, or obstruction. Diagnosis involves imaging such as endoscopy or CT scan followed by biopsy showing immunohistochemistry positive for CD117 in 95% of cases. Treatment involves surgical resection with clear margins although adjuvant therapy with imatinib is often used for higher risk tumors. Outcomes have improved greatly in the past two decades with 5-year survival rates now over 50% with appropriate treatment.
This document provides information on the management of soft tissue sarcoma. It discusses the clinical presentation, patterns of spread, imaging, histology, grading, staging, prognostic factors and management of soft tissue sarcomas. The key points are:
1) Soft tissue sarcomas most commonly present as painless swellings in the extremities and can invade locally along fascial planes. Imaging like MRI is important for assessing tumor extent.
2) Histologically, the most common subtypes are undifferentiated pleomorphic sarcoma and liposarcoma. Grading systems consider tumor differentiation, mitosis and necrosis.
3) Staging is based on tumor size, depth, nodal status and metastasis
This document provides an overview of carcinoma of the esophagus, including epidemiology, etiology, classification, diagnosis, staging, and management. It discusses the different types of esophageal cancer, risk factors, pre-malignant conditions, patterns of spread, diagnostic tools such as endoscopy and imaging, and the AJCC staging system. Treatment options are covered for early stage disease including endoscopic resection and ablation methods, as well as surgical approaches for localized and advanced disease, including transhiatal esophagectomy, Ivor-Lewis esophagectomy, and McKeown esophagectomy. Post-operative complications are also reviewed.
This document provides information about Pseudomyxoma Peritonei (PMP), including its historical background, epidemiology, pathology, clinical presentation, diagnosis, and treatment. It discusses the various theories about its origin and pathogenesis. Treatment involves aggressive cytoreductive surgery to remove all visible tumor deposits, followed by hyperthermic intraperitoneal chemotherapy (HIPEC) to treat any remaining microscopic disease. Combined modality treatment with complete cytoreduction and HIPEC can achieve long-term remission or cure. Recent studies show the importance of surgical experience, as morbidity and mortality decrease with increasing number of procedures performed.
Rectal carcinoma is the third leading cause of cancer death in the US. Risk factors include family history, inflammatory bowel disease, diet high in red meat and fat, and smoking. Staging follows the AJCC TNM system. Diagnosis involves history, physical exam, endoscopy, imaging like CT, MRI, PET. Treatment depends on stage but commonly includes surgery like low anterior resection or abdomino-perineal resection, with or without neoadjuvant chemoradiation, to completely remove the tumor while preserving sphincter function if possible. Ongoing surveillance after treatment monitors for recurrence or new cancers.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Gastric cancer is a major cause of cancer mortality worldwide. Risk factors include H. pylori infection, older age, smoking, and diets high in smoked/salted foods. Diagnosis involves endoscopy with biopsy. Staging uses TNM classification and evaluates tumor invasion depth, lymph node involvement, and distant metastasis. Treatment depends on stage but may include surgery, chemotherapy, and radiation. Prognosis is best for early stage cancers that can be completely surgically resected.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. They arise from interstitial cells of Cajal and can occur anywhere in the GI tract but are most common in the stomach. GISTs demonstrate mutations in genes like KIT or PDGFRA and are classified based on tumor size and mitotic rate to determine prognosis. Histologically, GISTs can be spindle cell, epithelioid, or mixed cell types and are typically positive for CD117, CD34, and DOG1 by immunohistochemistry, helping differentiate them from other soft tissue tumors. Prognosis depends on factors like tumor size, mitotic rate, site,
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
This document outlines a seminar plan on carcinoma of the pancreas presented by Dr. Jyotindra Singh. The seminar will cover topics such as the anatomy and surgical anatomy of the pancreas, pancreatic tumors, modes of presentation, pre-operative workup, various surgeries and surgical videos, recent updates, studies and trials, and a take home message. The seminar introduction discusses that carcinoma of the exocrine pancreas accounts for over 90% of pancreatic tumors and remains an oncologic challenge with a 5-year survival rate of 3%.
This document summarizes the management of pancreatic carcinoma. It discusses the anatomy, epidemiology, risk factors, hereditary syndromes, pathophysiology including pre-cancerous lesions, types of pancreatic cancer, staging, prognostic factors, diagnostic techniques, treatment including surgery, chemotherapy, targeted therapy, radiotherapy and historical prospective studies. It provides a comprehensive overview of pancreatic carcinoma covering all relevant aspects of the disease.
The document provides information on staging, grading, and management of breast carcinoma. It discusses the TNM classification system for primary tumor size, lymph node involvement, and metastasis. It also describes breast cancer staging based on TNM classification and 5-year survival rates. The document outlines methods for grading invasive breast cancers and discusses sentinel lymph node biopsy techniques. It then provides details on various surgical approaches for breast cancer management including total mastectomy, modified radical mastectomy, and breast-conserving surgeries. It also discusses radiotherapy and hormone/chemotherapy options and complications of treatment.
This document discusses carcinoma of the rectum. It begins by explaining the anatomy of the rectum and its blood supply, lymphatic drainage and innervation. It then discusses the epidemiology, risk factors, staging systems including Dukes and TNM classification. Signs and symptoms, diagnostic workup including endoscopic, radiological and biopsy evaluation are explained. Principles of surgical treatment including resection margins are outlined. The goal of surgery is eradication of the primary tumor along with adjacent mesorectal tissue.
The document discusses surgical management of chronic pancreatitis. It describes various surgical procedures for treating chronic pancreatitis including resection procedures like Whipple procedure, drainage procedures like Puestow's procedure, and hybrid procedures like Frey procedure. Studies have shown that duodenum-preserving pancreatic head resection procedures and longitudinal pancreaticojejunostomy provide better postoperative outcomes and pain control compared to resection procedures while preserving exocrine and endocrine function. The document concludes that surgery is effective for relieving pain in chronic pancreatitis and duodenum-preserving pancreatic head resection procedures have advantages over other surgical options.
Pancreatic cancer is the sixth leading cause of cancer death in the UK and the fourth leading cause in the US. It most commonly affects men over age 70. The majority (85%) are ductal adenocarcinomas that infiltrate locally and metastasize to the liver and peritoneum. Diagnosis involves imaging like CT scans and tumor marker tests. Surgical resection is the only potentially curative treatment but is only possible in 15-20% of cases due to late stage at presentation. Adjuvant chemotherapy may provide a survival benefit. Palliative options are aimed at relieving jaundice, gastric outlet obstruction, and pain. Prognosis remains poor with less than 5% of patients surviving 5
This document provides an overview of colorectal cancer. It discusses that colorectal cancer is the third most common cancer globally. The document outlines the anatomy of the colon and risk factors for colorectal cancer such as pre-cancerous conditions, hereditary syndromes, diet, radiation exposure and surgeries. It also describes the pathology, clinical presentation, investigations and treatments for colorectal cancer. Staging systems including Duke's and TNM classification are summarized. The document concludes with an overview of how colorectal cancer spreads.
1. Retroperitoneal sarcomas are rare soft tissue tumors that arise within the retroperitoneal space, with liposarcomas and leiomyosarcomas being the most common histological subtypes in adults.
2. Surgical resection with microscopically negative margins is the main treatment, but complete resection is difficult due to the large size and anatomic constraints; preoperative radiation may help increase resectability.
3. Outcomes are poor compared to other soft tissue sarcomas due to high rates of local recurrence after incomplete resection or positive margins, even with adjuvant radiation which is difficult to safely administer postoperatively.
Pancreatic cancer is the second most common gastrointestinal malignancy in the US. Risk factors include increasing age, male gender, African American race, smoking, obesity, and diabetes. The most common type is ductal adenocarcinoma, which accounts for 85-90% of cases. Overall survival is poor, with a 5-year rate of only 5%, due to most cases being diagnosed at an advanced stage when surgical resection is no longer an option.
Benign and Malignant Tumors of The Pancreasnur uyanık
This document provides an overview of benign and malignant tumors of the pancreas. It begins with the anatomy and physiology of the pancreas, describing its location, duct system, vasculature, and endocrine and exocrine functions. It then discusses different types of cystic tumors (serous cystadenoma, mucinous cystadenoma, intraductal papillary mucinous adenoma), adenocarcinoma, tumors of the ampulla of Vater, and endocrine tumors. Adenocarcinoma makes up about 85% of pancreatic cancers and has a very poor prognosis. Surgical resection remains the only potentially curative treatment option for pancreatic tumors.
This document discusses the management of colon cancers. It covers various treatment options including surgery, chemotherapy, and radiation therapy depending on the stage of cancer. For stage III colon cancer, adjuvant chemotherapy with FOLFOX or CapeOx is preferred after surgery to improve disease-free and overall survival based on clinical trials. Surgery aims to do an R0 resection with adequate margins and lymph node sampling. Laparoscopic surgery has comparable oncologic outcomes to open surgery.
Pseudomyxoma peritonei, also known as "jelly belly", is a condition characterized by mucus accumulation and disseminated tumor cells in the peritoneal cavity. It typically arises from a primary appendiceal or colon tumor that ruptures, releasing mucus and cells. Treatment involves surgical debulking to remove all visible tumor, followed by hyperthermic intraperitoneal chemotherapy to address remaining microscopic disease. Complete cytoreduction and low disease burden based on the peritoneal cancer index are associated with improved outcomes.
This document provides an overview of cholangiocarcinoma, a cancer originating from the bile duct epithelium. It discusses the risk factors, clinical presentation, diagnostic evaluation, staging, and treatment approaches for intrahepatic and extrahepatic cholangiocarcinoma. For resectable disease, the standard treatment is surgical resection with negative margins, while unresectable disease is treated with chemotherapy, radiation, palliative procedures, or best supportive care. Liver transplantation may be an option for highly selected patients with unresectable hilar cholangiocarcinoma.
This document discusses periampullary tumors, which arise near the ampulla of Vater. It defines periampullary tumors and lists the components that can be involved, including the bile duct, pancreatic duct, and duodenal mucosa. It then discusses cholangiocarcinoma, a type of bile duct cancer that can present as a periampullary tumor. Risk factors, clinical presentation, diagnosis, staging, treatment and prognosis of periampullary tumors are summarized. Surgical resection offers the best chance of survival, while unresectable tumors may be treated with stenting, radiation or chemotherapy to relieve symptoms.
This document provides an overview of gastric carcinoma, including:
- Causes of epigastric lumps that may indicate gastric carcinoma
- Risk factors like H. pylori infection, diet, smoking, and genetic factors
- Staging classifications including TNM, Lauren-Jarvi, and Borrmann systems
- Treatment approaches like endoscopic or surgical resection depending on stage, with lymph node dissection and reconstruction techniques described
- Adjuvant therapies including chemotherapy and radiation to improve survival
- 5-year survival rates are improved with neoadjuvant chemotherapy and adjuvant chemoradiation compared to surgery alone.
This document provides information about Pseudomyxoma Peritonei (PMP), including its historical background, epidemiology, pathology, clinical presentation, diagnosis, and treatment. It discusses the various theories about its origin and pathogenesis. Treatment involves aggressive cytoreductive surgery to remove all visible tumor deposits, followed by hyperthermic intraperitoneal chemotherapy (HIPEC) to treat any remaining microscopic disease. Combined modality treatment with complete cytoreduction and HIPEC can achieve long-term remission or cure. Recent studies show the importance of surgical experience, as morbidity and mortality decrease with increasing number of procedures performed.
Rectal carcinoma is the third leading cause of cancer death in the US. Risk factors include family history, inflammatory bowel disease, diet high in red meat and fat, and smoking. Staging follows the AJCC TNM system. Diagnosis involves history, physical exam, endoscopy, imaging like CT, MRI, PET. Treatment depends on stage but commonly includes surgery like low anterior resection or abdomino-perineal resection, with or without neoadjuvant chemoradiation, to completely remove the tumor while preserving sphincter function if possible. Ongoing surveillance after treatment monitors for recurrence or new cancers.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Gastric cancer is a major cause of cancer mortality worldwide. Risk factors include H. pylori infection, older age, smoking, and diets high in smoked/salted foods. Diagnosis involves endoscopy with biopsy. Staging uses TNM classification and evaluates tumor invasion depth, lymph node involvement, and distant metastasis. Treatment depends on stage but may include surgery, chemotherapy, and radiation. Prognosis is best for early stage cancers that can be completely surgically resected.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. They arise from interstitial cells of Cajal and can occur anywhere in the GI tract but are most common in the stomach. GISTs demonstrate mutations in genes like KIT or PDGFRA and are classified based on tumor size and mitotic rate to determine prognosis. Histologically, GISTs can be spindle cell, epithelioid, or mixed cell types and are typically positive for CD117, CD34, and DOG1 by immunohistochemistry, helping differentiate them from other soft tissue tumors. Prognosis depends on factors like tumor size, mitotic rate, site,
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
This document outlines a seminar plan on carcinoma of the pancreas presented by Dr. Jyotindra Singh. The seminar will cover topics such as the anatomy and surgical anatomy of the pancreas, pancreatic tumors, modes of presentation, pre-operative workup, various surgeries and surgical videos, recent updates, studies and trials, and a take home message. The seminar introduction discusses that carcinoma of the exocrine pancreas accounts for over 90% of pancreatic tumors and remains an oncologic challenge with a 5-year survival rate of 3%.
This document summarizes the management of pancreatic carcinoma. It discusses the anatomy, epidemiology, risk factors, hereditary syndromes, pathophysiology including pre-cancerous lesions, types of pancreatic cancer, staging, prognostic factors, diagnostic techniques, treatment including surgery, chemotherapy, targeted therapy, radiotherapy and historical prospective studies. It provides a comprehensive overview of pancreatic carcinoma covering all relevant aspects of the disease.
The document provides information on staging, grading, and management of breast carcinoma. It discusses the TNM classification system for primary tumor size, lymph node involvement, and metastasis. It also describes breast cancer staging based on TNM classification and 5-year survival rates. The document outlines methods for grading invasive breast cancers and discusses sentinel lymph node biopsy techniques. It then provides details on various surgical approaches for breast cancer management including total mastectomy, modified radical mastectomy, and breast-conserving surgeries. It also discusses radiotherapy and hormone/chemotherapy options and complications of treatment.
This document discusses carcinoma of the rectum. It begins by explaining the anatomy of the rectum and its blood supply, lymphatic drainage and innervation. It then discusses the epidemiology, risk factors, staging systems including Dukes and TNM classification. Signs and symptoms, diagnostic workup including endoscopic, radiological and biopsy evaluation are explained. Principles of surgical treatment including resection margins are outlined. The goal of surgery is eradication of the primary tumor along with adjacent mesorectal tissue.
The document discusses surgical management of chronic pancreatitis. It describes various surgical procedures for treating chronic pancreatitis including resection procedures like Whipple procedure, drainage procedures like Puestow's procedure, and hybrid procedures like Frey procedure. Studies have shown that duodenum-preserving pancreatic head resection procedures and longitudinal pancreaticojejunostomy provide better postoperative outcomes and pain control compared to resection procedures while preserving exocrine and endocrine function. The document concludes that surgery is effective for relieving pain in chronic pancreatitis and duodenum-preserving pancreatic head resection procedures have advantages over other surgical options.
Pancreatic cancer is the sixth leading cause of cancer death in the UK and the fourth leading cause in the US. It most commonly affects men over age 70. The majority (85%) are ductal adenocarcinomas that infiltrate locally and metastasize to the liver and peritoneum. Diagnosis involves imaging like CT scans and tumor marker tests. Surgical resection is the only potentially curative treatment but is only possible in 15-20% of cases due to late stage at presentation. Adjuvant chemotherapy may provide a survival benefit. Palliative options are aimed at relieving jaundice, gastric outlet obstruction, and pain. Prognosis remains poor with less than 5% of patients surviving 5
This document provides an overview of colorectal cancer. It discusses that colorectal cancer is the third most common cancer globally. The document outlines the anatomy of the colon and risk factors for colorectal cancer such as pre-cancerous conditions, hereditary syndromes, diet, radiation exposure and surgeries. It also describes the pathology, clinical presentation, investigations and treatments for colorectal cancer. Staging systems including Duke's and TNM classification are summarized. The document concludes with an overview of how colorectal cancer spreads.
1. Retroperitoneal sarcomas are rare soft tissue tumors that arise within the retroperitoneal space, with liposarcomas and leiomyosarcomas being the most common histological subtypes in adults.
2. Surgical resection with microscopically negative margins is the main treatment, but complete resection is difficult due to the large size and anatomic constraints; preoperative radiation may help increase resectability.
3. Outcomes are poor compared to other soft tissue sarcomas due to high rates of local recurrence after incomplete resection or positive margins, even with adjuvant radiation which is difficult to safely administer postoperatively.
Pancreatic cancer is the second most common gastrointestinal malignancy in the US. Risk factors include increasing age, male gender, African American race, smoking, obesity, and diabetes. The most common type is ductal adenocarcinoma, which accounts for 85-90% of cases. Overall survival is poor, with a 5-year rate of only 5%, due to most cases being diagnosed at an advanced stage when surgical resection is no longer an option.
Benign and Malignant Tumors of The Pancreasnur uyanık
This document provides an overview of benign and malignant tumors of the pancreas. It begins with the anatomy and physiology of the pancreas, describing its location, duct system, vasculature, and endocrine and exocrine functions. It then discusses different types of cystic tumors (serous cystadenoma, mucinous cystadenoma, intraductal papillary mucinous adenoma), adenocarcinoma, tumors of the ampulla of Vater, and endocrine tumors. Adenocarcinoma makes up about 85% of pancreatic cancers and has a very poor prognosis. Surgical resection remains the only potentially curative treatment option for pancreatic tumors.
This document discusses the management of colon cancers. It covers various treatment options including surgery, chemotherapy, and radiation therapy depending on the stage of cancer. For stage III colon cancer, adjuvant chemotherapy with FOLFOX or CapeOx is preferred after surgery to improve disease-free and overall survival based on clinical trials. Surgery aims to do an R0 resection with adequate margins and lymph node sampling. Laparoscopic surgery has comparable oncologic outcomes to open surgery.
Pseudomyxoma peritonei, also known as "jelly belly", is a condition characterized by mucus accumulation and disseminated tumor cells in the peritoneal cavity. It typically arises from a primary appendiceal or colon tumor that ruptures, releasing mucus and cells. Treatment involves surgical debulking to remove all visible tumor, followed by hyperthermic intraperitoneal chemotherapy to address remaining microscopic disease. Complete cytoreduction and low disease burden based on the peritoneal cancer index are associated with improved outcomes.
This document provides an overview of cholangiocarcinoma, a cancer originating from the bile duct epithelium. It discusses the risk factors, clinical presentation, diagnostic evaluation, staging, and treatment approaches for intrahepatic and extrahepatic cholangiocarcinoma. For resectable disease, the standard treatment is surgical resection with negative margins, while unresectable disease is treated with chemotherapy, radiation, palliative procedures, or best supportive care. Liver transplantation may be an option for highly selected patients with unresectable hilar cholangiocarcinoma.
This document discusses periampullary tumors, which arise near the ampulla of Vater. It defines periampullary tumors and lists the components that can be involved, including the bile duct, pancreatic duct, and duodenal mucosa. It then discusses cholangiocarcinoma, a type of bile duct cancer that can present as a periampullary tumor. Risk factors, clinical presentation, diagnosis, staging, treatment and prognosis of periampullary tumors are summarized. Surgical resection offers the best chance of survival, while unresectable tumors may be treated with stenting, radiation or chemotherapy to relieve symptoms.
This document provides an overview of gastric carcinoma, including:
- Causes of epigastric lumps that may indicate gastric carcinoma
- Risk factors like H. pylori infection, diet, smoking, and genetic factors
- Staging classifications including TNM, Lauren-Jarvi, and Borrmann systems
- Treatment approaches like endoscopic or surgical resection depending on stage, with lymph node dissection and reconstruction techniques described
- Adjuvant therapies including chemotherapy and radiation to improve survival
- 5-year survival rates are improved with neoadjuvant chemotherapy and adjuvant chemoradiation compared to surgery alone.
Gastric carcinoma is the major cause of mortality worldwide. It is more common in males than females and incidence peaks between 50-70 years of age. Risk factors include H. pylori infection, smoking, low socioeconomic status, and family history. Histologically, adenocarcinoma accounts for 90% of cases. Early detection is key to improving outcomes, as resection surgery can potentially cure localized disease, but prognosis is generally poor.
Pancreatic carcinoma is a relatively common and deadly form of cancer. The majority of pancreatic cancers are adenocarcinoma originating from the ductal cells. Risk factors include tobacco use, older age, genetic conditions, and chronic pancreatitis. Symptoms can include jaundice, abdominal pain, weight loss, and new-onset diabetes. Diagnosis involves blood tests for markers like CA19-9, imaging with CT, MRI, or EUS to identify tumors, and tissue sampling when needed. Surgical resection offers the only chance of cure but many tumors are inoperable at diagnosis due to late presentation and aggressive nature.
Colorectal cancer is the third most common cancer in the United States. The risk increases with age, with over 90% of cases being diagnosed in patients over 50 years old. Colorectal cancer can develop from pre-cancerous polyps through a process known as the adenoma-carcinoma sequence. Genetic and environmental factors can contribute to the development of colorectal cancer. Staging systems such as Dukes staging and TNM staging are used to determine the prognosis and appropriate treatment.
1. The document discusses various types of pancreatic cysts including pseudocysts, congenital cysts, and neoplastic cystic tumors.
2. It outlines benign cystic neoplasms like serous cystadenomas and malignant mucinous cystic neoplasms.
3. Pancreatic ductal adenocarcinoma is discussed as the fourth leading cause of cancer death which often has KRAS and p16 mutations and a desmoplastic response.
This document discusses neoplasms of the pancreas. It covers the epidemiology, risk factors, molecular genetics, pathology, staging, clinical features, diagnosis, management including surgical and non-surgical options, and postoperative results of pancreatic cancer. Some key points include that pancreatic cancer is the 4th leading cause of cancer death, risk factors include age, smoking, diet, and certain genetic syndromes. The most common type is ductal adenocarcinoma. Surgical resection if possible offers the only chance for cure, but postoperative mortality rates have decreased in recent decades.
This document discusses gastric cancer, including its incidence, risk factors, pathogenesis, clinical presentation, diagnostic evaluation, staging, and treatment approaches. Some key points include:
- Gastric cancer has a poor prognosis with only 20% 5-year survival. Early diagnosis is key.
- Risk factors include H. pylori infection, smoking, low socioeconomic status, and diets high in salt/preserved foods.
- Diagnosis involves endoscopy with biopsy. Staging evaluates tumor invasion and metastasis using CT, PET, and laparoscopy.
- Surgery offering total or subtotal gastrectomy is the only curative option, while chemotherapy and radiation are palliative.
1. The document discusses carcinoma of the head of the pancreas, including its epidemiology, risk factors, pathology, clinical features, imaging, staging, and surgical management via the Whipple procedure.
2. It provides details of the Whipple procedure, including exposing and dissecting key structures like the superior mesenteric vein, Kocher maneuver, dividing vessels like the gastroduodenal artery, and transecting the stomach and jejunum.
3. The Whipple procedure involves a pancreaticoduodenectomy to resect the pancreatic head tumors while preserving stomach, duodenum, common bile duct, and pancreas.
Gall bladder carcinoma seen in Indian popluation most common in women and presents at a very late stage .Survival is in months hence palliative treatment is being preferred .
Staging and investigation of ca kidney and bladderAtulGupta369
This document discusses staging and investigations for kidney and bladder cancer. It provides details on:
- Risk factors, pathological subtypes, and epidemiology of kidney cancer
- Genetic and non-genetic risk factors for bladder cancer
- Evaluations for diagnosis of both cancers including lab tests, imaging like CT, MRI, and pathology examination
- Presenting signs, symptoms, and classifications of bladder cancer
It is an informative overview of kidney and bladder cancers covering their risk factors, diagnostic workup, classifications, and epidemiology.
Dear Viewers,
Greetings from " Surgical Educator"
Today in this video I am going to talk on one more cause for Lower GI hemorrhage- Colorectal Carcinoma. I talk on the various causes for Lower GI hemorrhage, Etiopathogenesis, clinical features, investigations, staging, treatment and followup of Colorectal carcinoma. I have also included a mindmap, a diagnostic algorithm and a treatment algorithm. Hope you will enjoy the video. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
The document discusses risk factors, diagnosis, staging, pathology, and management of ovarian cancer. It notes that family history and nulliparity are strong risk factors. Diagnosis involves physical exam, tumor markers like CA125, ultrasound, and CT or MRI imaging. Staging follows FIGO guidelines from I to IV based on extent of spread. Ovarian cancer typically spreads via direct extension or through the peritoneal cavity. Treatment involves surgical staging and tumor debulking followed by chemotherapy, while radiation plays a limited role.
This document provides information on gastric carcinoma, including:
1. It describes the classification, epidemiology, risk factors, pathogenesis, histology, staging, clinical features, investigations, and management of gastric adenocarcinoma.
2. The main risk factors include H. pylori infection, dietary nitrites, genetic mutations, and polyps. Gastric adenocarcinoma is classified based on cell type, location, depth of invasion, and metastasis.
3. Management involves endoscopic resection for early cancers, while advanced cancers are treated with surgery such as gastrectomy, with or without chemotherapy and radiotherapy. Complications and palliative care are also discussed.
This document summarizes colorectal carcinoma, including risk factors, pathology, spread, staging, clinical features, diagnosis, differential diagnosis, and treatment options. It notes that colorectal carcinoma is the fourth most common cancer in females and second most common in males after lung cancer. Risk factors include advanced age, diet high in animal fat, genetic factors, and conditions like familial adenomatous polyposis or inflammatory bowel disease. Diagnosis involves examinations like sigmoidoscopy, colonoscopy, or barium enema to detect tumors. Treatment depends on tumor location and staging but may include surgery such as anterior resection or abdominoperineal resection with or without radiation, as well as palliative procedures.
Pancreatic Carcinoma Classification and Preoperative evaluation in Whipple's ...Dr.Bhavin Vadodariya
The document discusses pancreatic tumor classification and preoperative evaluation for Whipple's procedure. It summarizes the main types of pancreatic tumors including pancreatic ductal adenocarcinoma, cystic neoplasms like serous cystic neoplasm and mucinous cystic neoplasm, and pancreatic neuroendocrine tumors. For preoperative evaluation, CT scan is useful for assessing resectability while ERCP may help with biliary decompression. Tissue biopsy is not always needed but can provide confirmation when the diagnosis is uncertain.
1. Cancer develops through a multi-step process of carcinogenesis caused by both external and internal factors like viruses, chemicals, and genetic mutations.
2. Diagnosis involves biopsy and pathological examination to determine tumor type, stage, and grade. Treatment requires a multidisciplinary approach including surgery, radiation, chemotherapy, immunotherapy, and targeted therapies.
3. Early detection through screening programs can improve cancer outcomes by allowing for early diagnosis and treatment before it spreads. However, cancer remains difficult to treat once it has metastasized to distant organs.
This document discusses tumors of the small and large intestines. It begins by describing non-neoplastic polyps such as hyperplastic, hamartomatous, inflammatory, and lymphoid polyps. It then discusses neoplastic epithelial lesions including benign adenomas and malignant adenocarcinoma, carcinoid tumors, squamous cell carcinoma, and malignant melanoma. Mesenchymal lesions such as gastrointestinal stromal tumor (GIST) and lymphoma are also reviewed. Specific topics covered in more depth include familial adenomatous polyposis, the adenoma-carcinoma sequence in colorectal carcinoma development, carcinoid tumors, gastrointestinal lymphoma, and TNM staging of colorectal carcinomas
A 30-year-old female presented with a one month history of left iliac fossa pain, anorexia, weight loss, and vomiting for one week. Examination revealed a tender palpable mass in the left iliac fossa. CT scan showed sigmoid colon cancer with liver metastases. At laparotomy, a perforated sigmoid colon mass was found adhered to surrounding structures with pus collection. A sigmoid colectomy with end colostomy was performed.
Soft tissue injuries include closed injuries like bruises and abrasions, as well as open injuries such as lacerations, avulsions, and penetrating wounds. Soft tissue connects and surrounds internal organs and bones, and includes muscle, tendons, ligaments, fat, fibrous tissue, lymph and blood vessels. The document discusses the anatomy of soft tissue and skin, types of soft tissue injuries, patient assessment considerations, and emergency medical treatment for closed and open soft tissue injuries.
The document discusses investigations and treatments for varicose veins. It describes several non-invasive tests used to evaluate varicose veins such as venous Doppler, duplex scan, and plethysmography. Invasive tests such as venography and ambulatory venous pressure are also discussed but noted to now be obsolete. Treatment options covered include compression therapy, sclerotherapy, and ablative methods like the Trendelenburg operation which involves ligation of the long saphenous vein and its tributaries.
Benign prostatic hyperplasia (BPH) is a common benign tumor in older men that results from proliferation of cells in the prostate. It affects the transition zone of the prostate and causes obstruction of urine flow. Common symptoms include hesitancy, weak stream, urgency and frequency. Diagnosis is based on history, physical exam and symptom scoring. Treatment options range from watchful waiting for mild cases to medications, minimally invasive procedures or surgery for more severe cases. Alpha blockers and 5-alpha reductase inhibitors are first line medical therapies that work by relaxing prostate smooth muscle tone.
- Abdominal aortic aneurysm (AAA) is a localized dilatation of the abdominal aorta exceeding normal diameter of 3 cm. It is more common in males over 65 years of age and smokers.
- Risk factors include atherosclerosis, family history, hypertension, and connective tissue disorders. The weakened vessel wall leads to proteolytic degradation and rupture risk increases with size over 5 cm.
- Screening with ultrasound is recommended for high risk groups. CT/MRI further characterize anatomy and complications like thrombosis. Surveillance intervals are based on size. Elective open or endovascular repair is indicated over 5.5/5 cm or rapid growth. Medical management focuses on slowing progression.
This document discusses anorectal malformations, which are anomalies of the anorectal system, urogenital system, sacral spine, and perineal musculature. It describes the embryological development of the hindgut and cloaca. Various classifications of anorectal malformations are presented, including the Wingspread, Pena, Krickenbeck, and anatomic classifications. Associated anomalies are discussed. The document outlines the approach to examining and investigating a newborn with an anorectal malformation, including history, physical exam, and imaging studies. It discusses early management decisions and various surgical procedures for treating anorectal malformations.
Mammography is an x-ray test used to aid in the early detection and diagnosis of breast diseases in women. It uses low-dose radiation to produce images of the breast tissue. Screening mammograms are used to look for signs of breast cancer in women without symptoms, while diagnostic mammograms are used when abnormalities are detected or a woman has breast symptoms. Mammograms produce images of the breast tissue and can detect abnormalities such as masses, calcifications, architectural distortions, and asymmetries that may indicate breast cancer. The images are analyzed according to the Breast Imaging Reporting and Data System (BI-RADS) to determine if follow-up is needed. Digital mammography provides enhanced image quality compared to traditional film
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How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
Assessment and Planning in Educational technology.pptxKavitha Krishnan
In an education system, it is understood that assessment is only for the students, but on the other hand, the Assessment of teachers is also an important aspect of the education system that ensures teachers are providing high-quality instruction to students. The assessment process can be used to provide feedback and support for professional development, to inform decisions about teacher retention or promotion, or to evaluate teacher effectiveness for accountability purposes.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
4. EPIDEMOLOGY
Ninth most common cancer diagnosis
Ranks fourth in cancer deaths each year
Overall, less than 5% of individuals will survive 5
years beyond diagnosis
Men are affected slightly more commonly than
women, with a 1.3:1 incidence ratio.
Risk increases with age beyond sixth decade.
8. Hereditary Pancreatitis
PRSS1 – cationic trypsinogen gene
Mutations in this gene are responsible for 80% of
cases of hereditary pancreatitis
--Leads to increased trypsin activity and chronic
inflammation in the pancreas.
SPINK1gene – codes for serine protease inhibitor
that inhibits active protein.
Mutations in ths gene have been associated with
hereditary pancreatitis
9. Peutz – Jeghers syndrome
STK11 gene – thought to act as tumour suppressor
gene, with loss of heterozygosity leading to the
development of gastrointestinal tumours.
--Individuals with Peutz Jeghers syndrome are at
higher risk of lung, ovarian, breast, uterine and
testicular cancers.
--Risk of pancreatic cancer in Peutz Jeghers syndrome
is more than 100 times greater than that in unaffected
individuals.
10. Cystic Fibrosis:
CFTR GENE
Cause remains unclear
Elevated risk of pancreatic cancer is caused by the
chronic inflammatory condition of the pancreas
resulting from a lifetime of thickened secretions and
partial ductal obstruction.
11. Familial atypical mole and multiple melanoma
syndrome:
CDKN2A GENE
CDKN2A encodes protein p16, which normally
inhibits cell proliferation by binding to cyclin-dependent
kinases.
Mutations of CDKN2A lead to uninhibited cell cycle
activation and proliferation.
12. Hereditary Breast and Ovarian Cancer:
BRCA2 GENE
Germline mutations of BRCA2 gene lead to an
elevated risk of pancreatic carcinoma
Lynch Syndrome:
Mismatch repair genes-MLH1,MSH2,MSH6
Lynch syndrome also leads to an increased risk of
pancreatic cancer.
Microsatellite instability noted in colon cancer cells
has also been noted in pancreatic cancer cells from
individuals of Lynch Synndrome.
13. Familial Adenomatous Polyposis (FAP) :
APC Gene [Adenomatous Polyposis coli]
Individuals affected by familial adenomatous
polyposis are also significantly more likely to develop
pancreatic cancer.
Familial pancreatitis:
Unknown genetic mutations.
-Defined by families with two or more first degree
relatives wih pancreatic ductal adenocarcinoma that
do not fulfill the criteria of other inherited tumour
syndromes with an increased risk for development of
PDAC.
14. Sporadic Pancreatic Cancer:
--Most cases are sporadic.
--Development of PDAC from Pancreatic intraepithelial
Neoplasia [PanIn].
--Multiple Tumour suppressor genes and oncogenes
have been identified that play a sigificant role in the
pathogenesis of PDAC
PDX1, KRAS2, CDKN2A, P53 and DPC4/SMAD4.
15. KRAS2 Oncogene:
--Mutation of KRAS2 oncogene is one of the earliest
genetic abnormalities identified in progression of PanIn
to PDAC.
--Activated in more than 95% of pancreatic cancers
and is thought to be the initiating event in
tumourigenesis.
--KRAS2 is activated by point mutation [codon 12, 13,
61] , which causes constitutive activation and loss of
regulation of mitogen activated protein kinase cell
signal transduction.
16. CDKN2A/P16 :
--CDKN2A encodes protein p16 that binds to cyclin
dependent kinases CDK4, CDK6 resulting in cell cycle
arrest.
--Mutation of CDKN2A and loss of p16 leads to loss of
cell cycle regulation.
P53 :
--p53 encodes protein p53, which regulates cell
proliferation through cell cycle arrest and proapoptotic
mechanisms. Mutations in p53 has a significant role in
transition from non invasive to invasive tumours.
DPC4/SMAD4 :
--DPC4 functons as a downstream mediator related to
TGF-Beta,,,therefore loss of DPC4 leads to decreased
inhibition of cell growth and proliferation.
17.
18. PanIn—defined histologically by progressive
abnormality of the ductal epithelium from columnar
metaplasia through carcinoma in situ.
PanIn 1A- presence of columnar, mucin producing
ductal epithelium that maintains basally located
homogenous nuclei without atypia.
PanIn 1B- Development of papillary architecture
PanIn 2- Progression of simple papillary growth to
nuclear atypia.
PanIn 3- Enlarged nuclei with nuclear crowding and
loss of polarity and marked cytologic atypia
19. Periampullary Carcinoma:
It is tumour arising at or near the ampulla.
It can be
--Adenocarcinoma from the head of pancreas close to
the ampulla-50%
--Tumour from ampulla of vater-30%
--Distal bile duct carcinoma-10%
--Duodenal carcinoma adjacent to ampulla-10%
20. Pathology:
Gross :
Grayish white scirrhous nodular gritty tumour
More than 3 cm sized tumour shows nodal and
distant spread commonly.
Pancreatic duct may be dilated due to obstruction.
Microscopy :
It shows malignant cells with variable degree of
differentiation, high mitotic index, severe desmoplastic
reaction with fibrosis.
Shows vascular and lymphatic invasion
High propensity for perineural spread and so to
neural plexus causing back pain.
21. Clinical Presentation:
Jaundice – obstructive nature; severe progressive;
associated with pruritus. Painless in ampullary
malignancies.
Pain– right hypochondrium, epigastrium, left
hypochondrium depending on location of tumour.
Back pain may be present due to involvement of
retropancreatic nerves, or pancreatic duct
obstruction, or stasis, disruption of nerve sheath by
tumour. More at night and after intake of food;
relieves on leaning forward.
Diarrohea, Steatorrhea, Tea coloured urine.
Loss of appetite and Loss of weight.
22. New onset Diabetes in an elderly patient with weight
loss may be an early presenting symptom of
pancreatic cancer.
Left supraclavicular lymphnode enlargement
Secondaries in Rectovesical pouch [Blumer Shelf]
Periumbilical Lymphadenopathy [Sister Mary Joseph
Nodules]
Gallbladder may be palpable, nontender, moving
with respiration.
Liver enlargement– Secondaries
Ascites
23. Investigations:
Routine Surgical Profile
Liver Function Tests:
1]Serum bilirubin – Direct component increased
2]Serum Albumin – Decreased with altered A:G ratio.
3]Prothrombin time is increased.
4]Serum Alkaline Phosphatase is increased
24. Spiral CT -- imaging study of choice
Allows an accurate determination of the level of
biliary obstruction, size of tumour, retroperitoneal
lymphnodes.
Three phase CT-scan (noncontrast, arterial and portal
venous) with 3 mm slices and coronal and three
dimensional reconstruction should be routine.
--Pancreatic adenocarcinoma is typically seen as
hypoattenuating lesion during portal venous phase of
imaging.
ERCP -- assessment of jaundiced patient
-ability to perform a biopsy
-ability to palliate jaundice
25. Endoscopic Ultrasound --
Evaluation of peritumoural vasculature and regional
lymph nodes
Endoscopic Ultrasound guided biopsy/ FNAC.
For the identification of small tumours that do not
appear on CT scans and for the delineation of more
clearly suspicious lesions smaller than 2 cms
MRCP - detailed assessment of luminal
pancreatobiliary anatomy.
Non invasive ; no risk of inciting pancreatitis;
provides three dimensional reconstruction of the ductal
system.
26. STAGING :
Based on American Joint Committee on Cancer
tumour, Node, Metstasis [TNM ] system.
Accomplished typically based on Endoscopic
ultrasound guided FNAC, accurately by multidetector
CT scanning of the abdomen and pelvis with three
phase administration of contrast material and three
dimensional reconstruction.
27.
28. Depending on CT imaging, tumours are classified
into
-Resectable
-Borderline resectable
-Unresectable
Individuals with stages IA to IIB tumours- tumours
confined to pancreas or peripancreatic tissue without
evidence of celiac artery or SMA involvement and no
evidence of metastasis– are considered as
candidates for surgical resection.
29. Resectable tumours are defined as confined to the
pancreas with no evidence of SMV or portal vein
involvement and a preserved fat plane sorrounding the
SMA and celiac artery branches including hepatic artery.
Borderline resectable tumours are defined as tumours
that exhibit one of the following characteristics:
-severe unilateral or bilateral SMV- portal impingement
-less than 180 degree tumour abutment on the SMA.
-abutment or encasement of hepatic artery, if
recconstructible.
-SMV occlusion, if of a short segment and
reconstructible.
Unresectable tumours are those that exhibit metastasis,
ascites or vascular involvement .
30. Staging Laparoscopy
To reduce the frequency of nontherapeutic
laparotomy for patients with unsuspected metastatic
or locally advanced unresectable disease at the time
of surgery.
Indications:
-Large tumours of size > 3 cm
-Significantly elevated CA19-9 level (>100U/ml)
-Uncertain findings on CT
-Body or tail tumours.
31. Preoperative Preparation:
Correction of anemia.
Adequate hydration is important in order to prevent
dehydration postoperatively.
Replenishment of glycogen store.
Mannitol should be given intravenously 3 days prior
to surgery to flush the kidney—preventing
hepatorenal syndrome postoperatively.
Antibiotics one day prior to surgery.
TPN may be required preoperatively which is also
continued postoperatively.
Pulmonary function studies and respiratory
physiotherapy
32. Treatment:
Surgery for tumours of the head of the pancreas:
---Pancreaticoduodenectomy
WHIPPLE’S PROCEDURE.
Surgery for tumours of the Body and Tail of the
Pancreas:
---Distal pancreatectomy and en bloc spleenectomy.
35. Structures removed in Pancreaticoduodenectomy:
-Distal stomach
-Head of the pancreas
-Duodenum
-CBD
-Gall Bladder
-Proximal Jejunum
-Regonal Lymphatics
36. Surgery for tumours involving body and tail
of the pancreas:
These tumours are rarely resectable at the time of
presentation.
For resectable tumours --- Distal Pancreatectomy
and En bloc Spleenectomy should be performed.
38. Pancreatic fistula is the major source of morbidity
after the whipple operation.
Pancreatic Fistula defined as output via an
intraoperatively placed drain of any measurable
volume on or after postoperative day 3, with amylase
>3 times normal serum value.
Most fistulas are controlled by drainage catheters
placed at the time of surgery and require no
additional intervention
Uncontrolled fistulas require an additional drain
placement or completion pancreatectomy to prevent
further abdominal contamination.
39. Extent of Lymphadenectomy:
In addition to peripancreatic, portal and pyloric
lymphnodes, extended lymphadenectomy
includes retrieval of hilar and retroperitoneal
lymph nodes, extending from celiac origin to the
level of the inferior mesenteric artery and
including all tissue between the renal hilum
laterally.
40. Adjuvant therapy
The current guidelines recommend GEMCITABINE
or 5-FLUOROURACIL or in combination with 5- FU
based chemoradiation as adjuvant treatment after
resection.
For Metastatic carcinoma—FOLFIRINOX
-combinaton of 5-FU, Oxaliplatin, Irinotecan and
Leucovorin used as neoadjuvant regimen of choice in
patients with borderline resectable tumours.
44. Second most common exocrine pancreatic
neoplasm next to adenocarcinoma.
Types
-Mucinous
-Serous
-Intraductal Papillary Mucinous Neoplasms
45. MUCINOUS CYSTIC NEOPLASM
Most common cystic neoplasms of the
pancreas.
Most commonly in Young women, Men are rarely
affected.
Mean age at presentation is Fifth decade.
Typically found in the body and tail of the
pancreas
46. • Contain mucin-producing
epithelium
• Presence of mucin-rich cells and
ovarian-like stroma
• CT scan –solitary cyst with fine
septations, surrounded by a rim
of calcification.
• Predictors of malignancy
-Eggshell calcification, larger
tumor size,mural nodule on cross-
sectional imaging.
47. EUS and cyst fluid analyses demonstrate
--mucin-rich aspirate
--high CEA levels (>192 ng/mL)
--low levels of amylase
Standard treatment - Pancreatic resection and
adjuvant systemic chemotherapy after resection.
48. SEROUS CYSTIC NEOPLASM
Predilection for the head of the pancreas
Vague abdominal pain and less frequently with
weight loss and obstructive jaundice
Gross--Large , well circumscribed masses.
Microscopy - multiloculated, glycogen-rich small
cysts.
CT Scan-
Central calcification, with radiating septa giving the
sunburst appearance (10-20%)
49. Treatment:
Large (>4 cm) or rapidly growing, symptomatic
lesion--- Treatment is Resection
Small (<4 cm) --asymptomatic and can be kept for
observation.
50. Intraductal Papillary Mucinous Neoplasms:
Manifests in Sixth to seventh decade of life.
Commonly involves head of pancreas.
Wide spectrum of epithelial changes ranging from
benign adenoma, borderline, carcinoma insitu, and
invasive adenocarcinoma.
Types-
--Side branch or branch duct IPMN
--Main duct IPMNs
--Mixed -type IPMNs
51. Branch duct intraductal papillary mucinous
neoplasms:
Involves dilation of the pancreatic duct side branches
that communicate with but do not involve the main
pancreatic duct.
Focal (involving a single side branch) or multifocal.
Risk of malignant transformation directly related to
the size of the cystic dilation.
Others - mural nodules or general thickening of the
cyst wall symptoms like jaundice, pain, and diabetes.
52. Small (<1 cm) IPMNs:-
--Surveillance with CT or MRI in 1 year
Asymptomatic cysts ,1 -3 cm:-
--Imaging at 6 months followed by annual evaluation
if no change in size.
Cysts larger than 3 cm:-
--Surgical resection (Partial pancreatectomy)
Risk of invasive malignancy- 10% to 15%
53.
54.
55. Main duct intraductal papillary
mucinous neoplasm:
Abnormal cystic dilation of the main pancreatic duct
with columnar metaplasia
Endoscopy –thick mucinous secretions oozing from
patulous papilla
May be focal or diffuse
30% to 50% risk of harbouring invasive pancreatic
cancer at the time of presentation.
56. Treatment- Surgical resections as there is risk of
malignant transformation.
Predictors of malignancy-
--Jaundice
--Elevated serum alkaline phosphatase
--Mural nodules
--Diabetes
--Main pancreatic duct diameter of 7 mm
Elevation of the CEA level is not predictive of
invasive malignancy.
57. CT scan –
Dilated main pancreatic duct, cysts of varying sizes
and possibly mural nodules.
MRCP--localization of mural nodules and
pretreatment classification of suspected side branch
or main duct types of IPMN
Aspirated fluid is typically viscous and clear, contains
mucin and columnar mucinous cells with variable
atypia
Elevated CEA level (>192 ng/mL)
58. Mixed type intraductal papillary mucinous
neoplasms
Side branch IPMN that has extended to involve the
main pancreatic duct.
Risk of invasive malignancy at the time of
presentation (30% to 50%)
Surgical resection is indicated for the treatment.
62. INSULINOMAS
Most common functioning tumor
They arise from Beta cells of pancreas.
Equal distribution in the head, body, and tail.
97% are located in the pancreas, remaining 3% are
located in the duodenum, splenic hilum, or
gastrocolic ligament
Whipple’s triad
--Fasting-induced neuroglyopenic symptoms of
hypoglycemia
--Low blood glucose levels (40 to 50 mg/dL),
--Relief of symptoms after the administration of
glucose.
63. Clinical Features:
--Abdominal discomfort, tremors, sweating, hunger,
dizziness, diplopia, hallucinations. Later epilepsy and
unconsciousness.
--They are usually over weight. Weight gain is
common due to overeating.
--Permanent neurological deficits can occur with
behavioural changes.
64. Investigations:
• 72 hour fasting
test
- High level of serum
insulin (>5 μU/mL)
-Insulin-to-glucose
ratio higher than 0.3
-C peptide levels
higher than 1.2
μg/mL
• CECT or MRI--
Hyperattenuating
lesions because of
their rich vascular
supply.
65. Treatment
Enucleation commonly, often distal pancreatectomy
Diazoxide, beta blockers, phenytoin, verapamil,
steroids, growth hormone to control hypoglycaemia
Octreotide decreases the insulin secretion
Calcium channel blockers
Streptozotocin whenever secondaries are present in
liver or elsewhere
Enucleation of all tumours.
Often distal pancreatectomy is required (spleen; tail
and body of the pancreas are removed) 90% are
curable.
66. GASTRINOMAS
They arise from non-beta cells (G cells) of the
pancreas, which secretes high levels of gastrin.
It is 2nd most common endocrine pancreatic tumour.
It is the commonest endocrine pancreatic tumour
seen in MEN I syndrome. In MEN II syndrome lesion
is often seen in duodenum (30%).
It is common in males.
Common in gastrinoma triangle (Passaros triangle)
67. Gastrinoma triangle
(90%)
-The cystic duct CBD
junction
-The JUNCTION
between the second
and third portions of the
duodenum
-Junction between the
neck and body of the
pancreas
68. Half of them are multiple and malignant (50%).
It causes severe, multiple peptic ulcers in the
stomach,
duodenum and jejunum.
It is due to hypergastrinaemia causing high levels of
acid secretion.
Other features are diarrhoea, steatorrhoea,
hypokalaemia.
It causes ZES type II.
When malignant commonly present with secondaries
in liver(80%)/lymph nodes/lungs or bones.
69. Investigations:
Presence of hypergastrinemia in the presence of
increased secretion of gastric acid.
An elevated serum gastrin level coupled with a pH
lower than 2 in the gastric aspirate
Fasting levels of gastrin - higher than 1000 pg/mL
(upper limit of normal of 100 pg/mL)
An increase of more than 200 pg/mL in the gastrin
value after administration of secretin
70. Treatment:
60% are curable.
Enucleation of tumours.
Distal pancreatectomy.
Pancreaticoduodenectomy.
Subtotal pancreatectomy.
Often total gastrectomy may be required.
71. GLUCAGANOMAS
Arise from α cells of pancreas.
Common in body and tail of pancreas.
It is common in females.
It attains large size of 5-10 cm.
It is commonly sporadic. 17% associated with MEN
type II syndrome.
It is commonly malignant (80%). 80% spreads to
liver.
72. Clinical features:
Necrolytic migratory erythema (65%).
Diabetes (90%).
Diarrhoea and weight loss.
Stomatitis.
Anaemia and features of amino acid defi ciency.
73. Investigations:
MRI, CT scan.
Endosonography.
Angiogram.
Increased serum glucagon level. Fasting glucagon
level more than 50 p mol/litre is diagnostic.
Treatment
Distal Pancreatectomy
Dacarbazine is specially effective in Glucaganomas.
74. VIPOMAS
Arising from D2 cells of pancreas
Watery diarrhoea, hypokalaemia, achlorohydria
(WDHA syndrome)
Also called as pancreatic cholera or Verner-
Morrison syndrome, weak—tea syndrome
Usually malignant
Secretes vasointestinal polypeptide > 150 pg/ml
Common in body and tail—solitary
Distal pancreatectomy is the treatment of choice
Prednisolone controls the diarrhoea
Octreotide is useful
75. SOMATOSTATINOMAS
Usually solitary and 85% are larger than 2 cm.
Mostly at head of pancreas
Ninety percent are malignant
Steatorrhea , diabetes mellitus, hypochlorhydria, and
gallstones
Fasting somatostatin level higher than 14 mol/liter
Associated with von Recklinghausen’s disease and
pheochromocytomas.
Treatment remains the resection of the tumour.