الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Cancer of exocrine pancreas is the fourth leading cause of cancer related death in United States with 28,000 new cases (2% of all cancer diagnosis estimated in the year 2000). Many factors were associated with a higher incidence of pancreatic cancer such as tobacco smoking conferring about a two-fold increase risk, chronic and hereditary pancreatitis which is associated with 15-fold increase in risk for pancreatic cancer, occupational exposure to benzidine and gasoline derivatives and DM. The most common pathological type of pancreatic cancer is ductal adenocarcinoma, which form about 85-90% of cases. As most pancreatic cancers arise in the head of pancreas, obstructive jaundice is the hallmark presentation. Also, weight loss, epigastric pain present in 80% of patients, for lesion of body and tail the presentation include back epigastric ache, weight loss and advanced local disease. Staging evaluation should include history, physical examination and radiological study as abdominal CT, abdominal US, EUS, ERCP, PET and angiography. Surgery is the primary therapy for resectable pancreatic cancer, with curative resection, median survival is 15 months, and 5-year survival is 20%. Adjuvant chemradiation doubles median and long term survival after resection. For locally advanced disease, EBRT plus 5-Fu chemotherapy double the median survival and achieve a two-year survival of 10 to 20% and is effective in palliating symptoms of pain, for mestastatic disease systemic therapy is used. Endocrine pancreatic tumors are rare neoplasms with annual incidence of 1 per 100,000. EPT are classified into functional or secreting tumors which diagnosed by recognition of specific clinical syndrome and non-functional neoplasm which may present by pancreatic mass or metastatic disease from the start. Today, new techniques are used for diagnosis of EPT such as detection of elevated hormones in serum by RIA, abdominal US, abdominal CT and angiography. Only the effective treatment is the surgical removal of the tumor, however, non-operative (medical) treatment including diazoxide, somtatostatin analogues, corticosteroids and various chemotherapeutic agents such as 5-Flurouracil, streptozotocin and adriamycin, in certain situation such as metastatic disease)