Exocrine Pancreatic Cancer

1 Epidemiology.- 1.1 Frequency.- 1.2 Descriptive Epidemiology.- 1.2.1 Incidence by Age and Sex.- 1.2.2 Geographical, Racial, and Social Variations.- 1.3 Causal Epidemiology.- 1.3.1 Chronic Pancreatitis.- 1.3.2 Diabetes Mellitus.- 1.3.3 Dietary Habits.- 1.3.4 Chemical and/or Industrial Agents.- 2 Pathological Anatomy.- 2.1 Macroscopic Study.- 2.1.1 Macroscopic Morphology.- 2.1.2 Intraglandular Localization.- 2.2 Microscopic Study.- 2.2.1 Histological Types.- 2.2.2 Epineoplastic Pancreatitis.- 2.2.3 Pancreatic Cytology.- 2.2.4 Duct Hyperplasia-Cancer Relationship.- 2.3 Extraglandular Extension.- 2.3.1 Spreading by Contiguity.- 2.3.2 Spreading via the Venous Network.- 2.3.3 Spreading via Lymphatic Effluents.- 2.4 Classification of the Stages of Development.- 2.4.1 TNM Classification.- 2.4.2 Hermreck’s Classification.- 2.4.3 Cubilla’s Classification.- 2.4.4 A New Proposal.- 3 Clinical Features.- 3.1 Classical Types.- 3.1.1 Painful.- 3.1.2 Jaundiced.- 3.1.3 Cachectic.- 3.1.4 Tumor.- 3.2 False Types.- 3.2.1 Rheumatological.- 3.2.2 Gastrointestinal.- 3.2.3 Psychic.- 3.2.4 Febrile.- 3.2.5 Endocrine.- 3.2.6 Blood-Vascular.- 3.3 Metastatic Types.- 3.3.1 Pleural Effusion.- 3.3.2 Steatonecrosis.- 4 Biological Examinations.- 4.1 Standard Biology.- 4.2 Pancreatic Function Tests.- 4.3 Tumor Markers.- 4.3.1 Serological Markers.- 4.3.2 Antitumor Immunity.- 5 Morphological Examinations.- 5.1 Conventional Roentgenograms.- 5.1.1 Abdominal Plain Films.- 5.1.2 Upper Gastrointestinal Tract.- 5.2 Ultrasonography and Computerized Tomography.- 5.2.1 Ultrasonography (US).- 5.2.2 Computerized Tomography (CT).- 5.2.3 Value and Limitations of Ultrasonography and Computerized Tomography in Diagnosis of Pancreatic Cancer.- 5.3 Exploration of Bile Ducts and Wirsung’s Duct.- 5.3.1 Cholangiography.- 5.3.2 Endoscopic Retrograde Cholangiopancreatography (ERCP).- 5.3.3 Value and Limitations of Cholangiography and ERCP in Diagnosis of Pancreatic Cancer.- 5.4 Angiography.- 5.5 Laparoscopy.- 5.6 Percutaneous Needle Biopsy.- 5.6.1 Method.- 5.6.2 Diagnostic Accuracy.- 5.7 Magnetic Resonance.- 5.8 Morphological Diagnosis of the Principal Varieties of Pancreatic Tumors.- 5.8.1 Adenocarcinoma.- 5.8.2 Cystadenocarcinoma.- 5.9 Radiological Invasion Workup.- 6 Present Strategies for Diagnosis.- 6.1 Early Diagnosis.- 6.2 Presenting Symptoms.- 6.3 Further Investigations.- 6.4 Pretherapeutic Appraisal.- 6.5 Exploratory Laparotomy.- 6.6 Diagnostic Steps.- 6.7 Conclusion.- 7 Therapeutic Management.- 7.1 Pancreatectomies.- 7.1.1 Anatomical Basis for Surgery.- 7.1.2 Surgical Approaches.- 7.1.3 Techniques.- 7.1.4 Advantages and Disadvantages.- 7.2 Symptomatic Treatment.- 7.2.1 Surgical Biliary Bypass.- 7.2.2 Nonsurgical Biliary Drainage (External and Internal).- 7.2.3 Digestive Diversion.- 7.2.4 Analgesia.- 7.3 Chemotherapy and Radiation Therapy.- 7.3.1 Chemotherapy.- 7.3.2 External Beam Irradiation.- 7.3.3 Internal Radiation Therapy.- 7.3.4 Combined Radiation Therapy and Chemotherapy.- 8 Results of Therapy.- 8.1 Pancreatic Resection Versus Palliative Bypass.- 8.2 Results in Relation to Extent of Resection.- 8.2.1 Rate of Resectability.- 8.2.2 Percentage of Cures.- 8.2.3 Operative Mortality and Morbidity.- 8.3 Symptomatic and Adjuvant Therapies.- 9 Present Treatment Strategies.- 9.1 The Various Patient Groups.- 9.1.1 Operability.- 9.1.2 Resectability.- 9.1.3 Curability.- 9.2 Exploratory Laparotomy.- 9.2.1 Pancreatic Biopsy.- 9.2.2 Abdominal Metastases.- 9.2.3 Invasion of Adjacent Vessels.- 9.2.4 Lymph Node Involvement.- 9.3 Curative Strategies.- 9.3.1 Pancreatectomies.- 9.3.2 The Problem of Jaundice.- 9.3.3 Localization and Stage of Development.- 9.3.4 Adjuvant Treatments.- 9.4 Palliative Strategies.- 9.4.1 Palliative Surgery.- 9.4.2 Adjuvant Therapies.- 9.5 Inoperable Patients.- 9.5.1 Jaundice.- 9.5.2 Nutrition.- 9.5.3 Pain.- 9.5.4 Radiation Therapy and Chemotherapy.- 9.6 Conclusion.- 10 Intensive Care.- 10.1 Nutritional Deficiency and Support.- 10.1.1 Nutritional Deficiency.- 10.1.2 Nutritional Support.- 10.2 Pain.- 10.2.1 ChronicPain.- 10.2.2 Postoperative Pain.- 10.3 Organic Predisposition.- 10.3.1 Age.- 10.3.2 Respiratory Function.- 11 Treated Patients.- 11.1 Prognostic Factors.- 11.1.1 General Factors.- 11.1.2 Oncological Factors.- 11.1.3 Therapeutic Factors.- 11.2 Quality of Survival.- 11.2.1 After Resection.- 11.2.2 After Palliative Treatment.- 11.2.3 Inoperable Patients.- 11.3 Follow-up.- 12 Conclusion.- 13 Subject lndex.