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Metastatic pancreatic carcinoma
Other Resources UpToDate PubMed

Metastatic pancreatic carcinoma

Contributors: Abhijeet Waghray MD, Christine Osborne MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Metastatic pancreatic carcinoma is cancer arising from the pancreas that has spread to a distant location such as the liver, peritoneum, mesentery, mesenteric lymph nodes, and surrounding vasculature. The majority (95%) of malignant pancreatic carcinoma arises from the exocrine pancreas (related to the pancreatic ductal and acinar cells and their stem cells).

Pancreatic cancer is the seventh leading cause of cancer-related deaths in the world, which may be related to the fact that at the time of diagnosis, most pancreatic cancers have already spread outside of the pancreatic parenchyma.

Pancreatic tumors arising from the head and neck of the pancreas (60%-70% of exocrine pancreatic cancers) may spread locally to the celiac axis or the peripancreatic and periportal areas. Pancreatic tumors arising from the tail of the pancreas (20%-25% of exocrine pancreatic cancers) may spread to the common hepatic artery, celiac axis, splenic hilum, or splenic artery. Patients with spread to the mesentery may present with ascites.

The most common presenting symptoms in patients ultimately found to have metastatic pancreatic cancer include generalized weakness (asthenia) and weight loss and anorexia (83%-86%). Abdominal pain is also very common (71%-79%). A little over half of patients will present with jaundice.

Codes

ICD10CM:
C25.9 – Malignant neoplasm of pancreas, unspecified

SNOMEDCT:
363418001 – Malignant tumor of pancreas

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

As the signs and symptoms of metastatic pancreatic cancer are very nonspecific, the differential can be extremely broad.

On the differential of fatigue, weight loss, and anorexia:
  • Other neoplastic diseases (eg, Esophageal carcinoma, Gastric cancer)
  • Pancreatitis (Acute pancreatitis and Chronic pancreatitis)
  • Chronic pancreatitis
  • Peptic ulcer disease or Duodenal ulcer
  • Hypothyroidism
  • Depressive disorders
  • Gastroparesis
The differential in the context of new-onset jaundice should include:
  • Hemolytic anemia
  • Gilbert disease
  • Crigler-Najjar syndrome
  • Dubin-Johnson syndrome
  • Rotor syndrome
  • Choledocholithiasis
  • Pancreatic carcinoma (and other pancreatic cancers)
  • Cholangiocarcinoma (and other pancreaticobiliary malignancies)
  • Acute cholangitis
  • Primary sclerosing cholangitis
  • Primary biliary cholangitis
  • Hepatocellular carcinoma
  • Liver cirrhosis
  • Acute or chronic hepatitis (eg, Hepatitis A virus infection, Hepatitis B virus infection, Hepatitis C virus infection)
  • Cholestasis of pregnancy
  • Acute fatty liver of pregnancy
  • HELLP syndrome
  • Bacterial sepsis
  • Wilson disease
  • Celiac disease with microvesicular / macrovesicular liver injury
  • Autoimmune hepatitis
  • Alcoholic hepatitis
  • Hypothyroidism with subsequent liver injury
  • Hemochromatosis

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:07/14/2020
Last Updated:07/14/2020
Copyright © 2024 VisualDx®. All rights reserved.
Metastatic pancreatic carcinoma
A medical illustration showing key findings of Metastatic pancreatic carcinoma : Abdominal pain, Fatigue, Jaundice, Ascites, Epigastric pain, Anorexia, Cachexia
Imaging Studies image of Metastatic pancreatic carcinoma - imageId=8360130. Click to open in gallery.  caption: '<span>Axial image from enhanced CT scan of the abdomen showing a low attenuation mass at the pancreatic tail, (long arrow), consistent with pancreatic cancer with associated multiple low attenuation liver lesions, consistent with metastases, (short arrow).</span>'
Axial image from enhanced CT scan of the abdomen showing a low attenuation mass at the pancreatic tail, (long arrow), consistent with pancreatic cancer with associated multiple low attenuation liver lesions, consistent with metastases, (short arrow).
Copyright © 2024 VisualDx®. All rights reserved.