Contents

## **Preface XI**


Preface

and unknown factors.

course with a great experience in the field.

has achieved advances in diagnosis and treatment.

known reason, loss of appetite, and marked fatigue.

whether the cancer can be resected.

however, does not preclude recurrence.

It is a great pleasure and honor for me to present this interesting book about pancreatic can‐ cer, which has been written by an international group of experts, medical doctors, university professors, and basic researchers, all of them are actively working on this subject and of

This book presents the actual state of the pancreatic tumor, specifically referred to as adeno‐ carcinoma of the pancreas because this is the more common primary malignant tumor and

The incidence of pancreatic carcinoma has markedly increased over the past several decades and ranks as the fourth leading cause of cancer death all over the world. Despite the highmortality rate associated with pancreatic cancer, its etiology is poorly understood. Risk fac‐ tors for development of this kind of malignant tumor include a family history of pancreatic cancer, heavy cigarette smoking, obesity, chronic pancreatitis of long-standing evolution,

Pancreatic cancer symptoms depend on the site of the tumor within the pancreas and the degree of tumor involvement. In the early stages of pancreatic cancer, there are not many noticeable symptoms. As the cancer grows, symptoms may include jaundice, light-colored stools or dark urine, pain in the upper or middle abdomen and back, weight loss for un‐

It is a tumor difficult to detect and diagnose for the following reasons. There are no noticea‐ ble signs or symptoms in the early stages of pancreatic cancer. The signs when present are like the other found in many other benign illnesses, such as chronic pancreatitis or peptic ulcer. The pancreas is obscured by other organs in the abdomen and is difficult to visualize clearly on imaging tests. To appropriately treat pancreatic cancer, it is crucial to evaluate

The use of imaging technology may aid in the diagnosis of pancreatic cancer and in the identi‐ fication of patients with disease that is not amenable to resection. Imaging tests that may be used include helical computed tomographic (HCT) scan, magnetic resonance imaging (MRI) scan, and endoscopic ultrasound (USE). Minimally invasive techniques, such as laparoscopy and laparoscopic ultrasound, may be used to decrease the use of unnecessary laparotomy. No tumor-specific markers exist for pancreatic cancer; markers such as serum cancer antigen (CA) 19-9 have a low specificity. Most patients with pancreatic cancer will have an elevated CA 19-9 at diagnosis. Following or during a definitive therapy, an increase in CA 19-9 levels may identify patients with progressive tumor growth. The presence of a normal CA 19-9,

