Specimen

— pancreatic and ampullary cancers classically present with painless obstructive jaundice and investigation includes liver function tests, serum CA19-9, and OGD/ERCP with cytology and biopsy. Ultrasound can confirm duct obstruction and staging for local and distant disease also includes magnetic resonance cholangiopancreatography, CT scan chest, abdomen and pelvis and PET scan. Staging laparoscopy may also be done prior to consideration of radical surgery. Pancreatic endocrine tumours more often present as a consequence of a functional hormonal syndrome and localization of the primary lesion and metastases is by octreotide and CT scans. Treatment entails complete local excision of the primary tumour with a combination of surgery and medical treatment for metastatic disease.

— endoscopic brushings or biopsy/transduodenal or percutaneous fine-needle aspirate (FNA) or needle core biopsy.

— Whipple's procedure (partial gastrectomy, duodenectomy and partial pancreatectomy). A pylorus-preserving pancreaticoduodectomy may be used for small peri-ampullary tumours, thus maintaining the storage and release functions of the distal stomach and proximal 3 cm of duodenum.

— total pancreatectomy (partial gastrectomy, duodenectomy, total pancreatectomy and splenectomy).

— weight (g) and size/length (cm), number of fragments.

Carcinomas of the ampulla and head of pancreas are considered together because of their anatomical juxtaposition, overlap and common potentially operative resection (Whipple's procedure). A majority of ampullary cancers are operable but only a minority of pancreatic carcinomas.

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