**Section 4**

**Diseases of the Liver and Biliary Tract** 

458 New Advances in the Basic and Clinical Gastroenterology

Uchiyama-Tanaka, Y.; (2009). Colon irrigation and lymphocyte movement to peripheral

Van der Waaij, D.; Berghuis-de Vries, JM., Lekkerkerk van der ,Wees. (1971). Colonization

pp.504-510.

pp. 405-411.

blood. *Biochemical Research.* 30:pp. 311-314.

both thymus-derived T cells and extrathymic T cells in mice. *Immunol Cell Biol*. 83:

resistance of digestive tract in conventional and antibiotic treated mice. *J Hyg*. 67:

**22** 

Nam Q. Nguyen

*Australia* 

*North Terrace, Adelaide, SA* 

**Pancreato-Biliary Cancers – Diagnosis and Management** 

*Department of Gastroenterology, Royal Adelaide Hospital,* 

Pancreato-biliary cancers are relatively uncommon and in general, including cancers arise from the pancreas, bile duct and major ampullae. These tumours are uniformly carried a poor prognosis due to late presentation and surgical resection is only possible in less than 20% patients (David et al., 2009; Luke et al., 2009). Despites many medical advances in the imaging diagnosis, chemo-radio-therapy, surgical technique and post-operative care over the last 2 decades, the overall survival of patients with pancreato-biliary neoplasm has not improved significantly (Luke et al., 2009). The aim of the current chapter is to review and discuss current techniques and approaches to the diagnosis and management of pancreato-

In the Western world, pancreatic cancer is the fourth leading cause of cancer related mortality with the approximate incidence of 11 per 100 000, and ranks second after colorectal cancer among all gastrointestinal malignancies (Shaib et al., 2006). Men are more frequently affected than women and over 80% patients are diagnosed at the age older than 60 years. Almost 50% patients have distant metastases at the time of presentation with poor 5-year survival of 5% (Shaib et al., 2006). Recent data suggest that although the mortality rate for males has decreased by 0.4% from 1990 to 2005, the mortality rate for females has increased by 4.4% (Shaib et al., 2006; Jemal et al., 2009). The reason for this gender difference in mortality is unknown. Risk factors for pancreatic cancer include smoking, alcohol, diabetes mellitus, chronic pancreatitis, family history of pancreatic cancer. Patients with hereditary pancreatitis, Puetz-Jeghers syndrome, familial atypical multiple mole melanoma, familial breast and ovarian cancer, Li-Fraumeni syndrome, Fanconi anaemia, ataxiatelangiectasia, familial adenomatous polyposis, cystic fibrosis and possible hereditary nonpolyposis colon cancer syndrome are also at higher risk of having pancreatic cancer (Shaib

Ductal infiltrating adenocarcinoma is the most common type of pancreatic cancer with 78% located in the head, 11% in the body and 11% in the tail (Lillemoe et al., 2000; Ghaneh et al.,

**1. Introduction** 

biliary neoplasm.

**2.1 Pancreatic carcinoma** 

et al., 2006; Klapman and Malafa, 2008).

**2. Clinico-pathology of pancreato-biliary tumours** 
