Cancer of the pancreas is the fifth leading cause of cancer death in the United States. Almost 30,000 new patients will be diagnosed with pancreatic cancer in 2003, and at least 28,000 of these individuals will die of the disease. Because there are no proven or standardized laboratory or radiologic diagnostic tests for pancreatic carcinoma, most patients present with locally advanced or metastatic disease. The patients with the highest probability of long-term survival are those who present with AJCC early-stage disease (Table 1-5). This translates into cancer localized to the pancreas that can be resected completely, with no regional nodal, peritoneal, or liver metastases. Unfortunately, fewer than 10% of patients diagnosed with pancreatic adenocarcinoma present with surgically treatable disease.
The rapid onset of jaundice is the most frequent complaint of patients with pancreatic-head cancers. Patients with tumors originating in the body or tail of the pancreas may present with abdominal or back pain or with upper GI bleeding from splenic vein thrombosis and resultant gastric
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