الفهرس 
Anatomy of the pancreasOnly 14 pages are availabe for public view
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Abstract
Pancreatic carcinoma is one of the most aggressive human malignances. It is the tenth most common malignancy and the fourth largest killer in adult. It has an over all cumulative 5 years survival rate below 1%.
The cause of pancreatic carcinoma remains unclear, there are many risk factors for developing pancreatic carcinoma as tobacco smoking, high fatty meal, alcohol consumption, diabetes mellitus, pernicious anemia, chronic pancreatitis, cholelithiasis, gastric surgery, radiation and genetic factors.
Pancreatic carcinoma is uncommon before the age of 45 years old, more than 80% of pt are aged 60-80 years.
Approximately 90% of pancreatic exocrine tumors arise from pancreatic ductules and 80%of these tumors are adenocarcinoma, 60-70% arise in the head and the rest of the tumors located in the body or tail or diffusely through out the gland.
Over 90% of patients with pancreatic carcinoma present in the late stage due to a symptomatic tumor and vague complaint. Because of its deep seated inaccessible location the pancreas is difficult visualize and investigate. There are many methods for pancreatic investigation as US, CT, angiography MRI, ERCP, endoscopic US, tumor markers as CA19.9, CEA, POA and fine needle aspiration cytology.
In more than 80% of patient the tumor is irresectable at the time of diagnosis. Surgical resection of pancreatic carcinoma offers the only chance for long term survival. Over past two decades significant advances have been made in surgical techniques and peri-operative care of the patient.
The operative management of pancreatic carcinoma involving head neck and uncinate process consists of 2 phases, first assessing tumor respectability and then if the tumor is respectable completing a pancreaticoduden-ectomy and restoring gastrointestinal continuity.
Pylorus preserving pancreaticodudenectomy seems to provide a more favorable post operative course than standard pancreaticodudenectomy.
Adjuvant chemo radiotherapy as 5florouracil and gemcitabin improve the results of surgery as regard long term survival and local recurrence.
Surgical palliation of irresectable pancreatic tumor as for gastric out let obstruction by gastric by pass and for biliary obstruction by ERCP or by pass and pain therapy by celiac plexus block can improve the quality of life of these patients.