Pancreatic tumors

1. Big picture

For the final exam, pancreatic tumors mainly means pancreatic ductal adenocarcinoma until proven otherwise. It is aggressive, often diagnosed late, and classically presents with:

Weight loss + painless progressive jaundice + dark urine/pale stool + pruritus → think pancreatic head carcinoma.

The examiner usually wants you to recognize:

1. Pancreatic head tumor → obstructive jaundice, Courvoisier sign.
2. Body/tail tumor → late vague epigastric/back pain, weight loss, metastases.
3. CA 19-9 is not a screening or diagnostic test; it is mainly for follow-up.
4. Contrast-enhanced pancreas-protocol CT is the key staging test.
5. Surgery is the only curative option, but most patients are unresectable at diagnosis.
6. Pancreatic neuroendocrine tumors and cystic pancreatic tumors are different entities and usually have better prognosis than ductal adenocarcinoma.

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