الفهرس 
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Abstract
Pancreatic cancer is one of the most common causes for cancer related death. The overall five years survival rate ranges from 0.4% to 4%. Early diagnosis of pancreatic cancer is difficult because its early symptoms are usually non-specific. Local vascular involvement, nodal and distant metastases are frequently found at the time of diagnosis. (Pisters et al., 2001)
Incidence of pancreatic cancer increases in industrial countries. Its incidence is about 10 cases per 100,000 populations in UK and USA. The peak of incidence occurs in the sixth to eighth decades of life about 80%. Male to female incidence is about 1.2. (Coupland, 2012)
Aetiology of pancreatic cancer is unknown but it is thought that old age, smoking, obesity, chronic pancreatitis, high dietary fat, family history of pancreatic cancer or other rare genetic conditions increase risk. (Fuchs, 1996)
Main presenting signs and symptoms of pancreatic cancer are; anorexia, weight loss, upper abdominal pain, back pain in advanced cases, jaundice, malnutrition, steatorrhoea and sometimes gastric outlet obstruction. (Anderson, 2006)
Spiral CT with contrast is the corner stone in pancreatic cancer diagnosis and staging, which has been shown to be almost 100% accurate in predicting unresectable disease. However, approximately 25%-50% of patients with resectable disease on CT are found to have unresectable lesions of laparotomy. (Pappas et al., 2007)
ERCP and MRCP are helpful investigations if CT is equivocal and in patients with ampullary tumors as ERCP provides the opportunity for
direct visualization, biopsy, brushing cytology and biliary stenting if obstructed. (Hanbidge, 2002)
Resectability of pancreatic tumor was defined as a tumor limited to the pancreas with no invasion of the superior mesenteric artery and vein, portal vein and no metastases. (Pappas et al., 2007)
Carbohydrate antigen 19-9 (CA19-9) is the gold standard serologic marker for pancreatic cancer. Originally described as a marker for colon cancer, the CA19-9 antigen is sialylated lacto-N-fucopentoase II related to the Lewis blood group antigen. The sensitivity and specificity of CA19-9 in diagnosis of pancreatic cancer has been reported to be as high as 90% and 98%, respectively. A significant limitation of the use of CA19-9 as a marker for pancreatic cancer is its elevation in the setting of benign, as well as malignant, biliary obstruction. Biliary decompression usually results in a decrease in CA19-9 levels corresponding to a fall in serum bilirubin. (Kilic et al., 2006)
The normal value of CA19-9 ranges from 0 to 39 U per ml and almost all patients with a CA19-9 greater than 200 U per ml will have a pancreatic malignancy. Serum CA19-9 level has been shown to correlate with the TNM staging, and tumor size in patients with pancreatic cancer. It also has a major role in monitoring treatment response and a good predictor in surveillance for recurrence of metastatic disease. CA19-9 is commonly used not only to diagnose pancreatic cancer, but it may also help identify patients with resectable tumors. (Misek et al., 2007)
Management of resectable or localized pancreatic cancer achieved surgically through pancreaticoduodenectomy either with pylorus preservation or not followed by adjuvant therapy 4-8 weeks postoperatively. Surgical resection is the only modality that offers potential cure for pancreatic cancer. Median survival post resection
remains poor which ranges from 15-19 months. (Henne-Bruns et al., 2000)
In metastatic or unresectable cases chemotherapy or chemoradiotherapy and palliative intervention is the best. No benefit of surgical resection in advanced cases as there is no difference in survival between resection with residual and non-operative management (Ishikawa et al., 1989)