Early diagnosis of pancreatic cancer is difficult because the symptoms are so
non-specific and varied. Common symptoms include abdominal pain, loss
of appetite, significant weight loss, jaundice, digestive problems, and
depression.
Pancreatic cancer is usually discovered during the course of the
evaluation of these symptoms by e.g. abdominal CT. Endoscopic
ultrasound (EUS) is another procedure that can help visualize the tumor
and obtain tissue to establish the diagnosis.

Treatment of pancreatic cancer depends on the stage
of the cancer [1] Recent advances have made resection of tumors that
were previously unrescetable due to blood vessel involvement possible.
The Whipple procedure is the most common surgical treatment for cancers
involving the head of the pancreas.

Patients diagnosed with pancreatic cancer typically
have a poor prognosis because the cancer usually causes no symptoms
early on, leading to metastatic disease at time of diagnosis. Median
survival times from diagnosis of 3-4 months are not unknown.
Pancreatic cancer occasionally may result in diabetes. The insulin
production is hampered and it has been suggested that the cancer can
also prompt the onset of diabetes and vice versa.

The Whipple procedure is a technique of
pancreaticoduodenectomy, or surgical removal of pancreatic cancer. It
was named for American surgeon Dr. Allen Whipple who devised the
procedure in 1935 and subsequently came up with multiple refinements to
his technique. (Surgeons in training are often quizzed on the
refinement he made that provided the most improvement in outcomes to
that date: the use of non-absorbable silk over absorbable catgut
suture.)
The first resection for a periampullary cancer was performed by the
German surgeon Kausch in 1909.

The Whipple procedure today is very similar to
Whipple's original procedure. It consists of removal of the distal half
of the stomach (antrectomy), the gall bladder (cholecystectomy), the
distal portion of the common bile duct (choledochectomy), the head of
the pancreas, duodenum, proximal jejunum, and regional lymph nodes.
Reconstruction consists of attaching the pancreas to the jejunum
(pancreaticojejunostomy) and attaching the common bile duct to the
jejunum (choledochojejunostomy) to allow digestive juices and bile to
flow into the gastrointestinal tract and attaching the stomach to the
jejunum (gastrojejunostomy) to allow food to pass through.
Originally performed in a two-step process, Whipple refined his
technique in 1940 into a one-step operation.
Using modern operating techniques, mortality from a Whipple procedure
is around 5% nationwide (3% in high volume academic centers).

// posted by will @ 6:11 PM