Pancreatic Malignancy

Patients with long standing chronic pancreatitis are at a 10% lifetime risk for the development of pancreatic adenocarcinoma. During examination for surgery in a patient with chronic pancreatitis, imaging studies may show focal changes in the pancreas that suggest malignancy, or other aspects of the clinical presentation (eg, rising or markedly elevated CA19-9, change in character of pain, accelerated weight loss) may have raised the clinician's index of suspicion about the possibility that cancer is present.

If there is concern about malignancy, we recommend EUS examination, which is currently the most sensitive diagnostic study to identify small cancers, and also can be used to obtain tissue from the lesion that could confirm the diagnosis. EUS and FNA are discussed in Chapter 5 ("Endoscopic Ultrasonography and Fine-Needle Aspiration").

However, whether or not the diagnosis is confirmed pre-operatively, patients in whom the surgeon suspects the coexistence of pancreatic cancer with underlying chronic pancreatitis require pancreatic resection. This means a pan-creaticoduodenectomy for head and uncinate lesions and a distal pancreatectomy for body and tail lesions. Even if cancer is not found when the resected specimen is examined by the pathologist, this approach represents the current standard of care in such circumstances. This is because resection operations are safe, they are one of the standard operations normally done for chronic pancreatitis without coexisting cancer, and pancreatic cancer is uniformly fatal when it is not surgically resected.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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