Review Question - QID 101123

A palpable, enlarged, non-tender gallbladder is known as Courvoisier's sign and is indicative of adenocarcinoma at the head of the pancreas.

Risk factors for pancreatic cancer include age greater than 50, smoking, diabetes mellitus, genetics/family history, and chronic pancreatitis. Other physical findings in adenocarcinoma at the head of the pancreas are weight loss and jaundice due to compression of the common bile duct by the cancerous lesion. Tumors at the tail and body of the pancreas often present with weight loss and mid-epigastric pain.

Freelove et al. discuss the diagnosis of pancreatic cancer, including symptoms and physical examination findings. Pancreatic cancer is the fourth leading cause of cancer deaths in the United States, and more than half of all cases have distant metastasis at diagnosis. Most cases are non-resectable. Cases that are resectable are treated with pancreaticoduodenectomy (the Whipple procedure).

Maringhini et al. evaluated signs of pancreatic cancer in 80 afflicted patients among 940 controls. They found that the most sensitive criteria were ultrasonography (83%), weight loss (66%), and bilirubin level of > 3 mg/dl (61%); the most specific were ultrasonography (99%), recent-onset diabetes (97%), and a distended palpable gallbladder (94%).

Illustration A shows axial CT of adenocarcinoma of the head of the pancreas. Note the macrocystic head at the center of the image.

Incorrect Answers:
Answer 1: This describes the Sister Mary Joseph sign which is seen with gastric cancers.
Answer 2: Acanthosis nigricans is a poorly defined, brown or black thickening of the skin. It is associated with adenocarcinomas of the GI tract and uterus or diabetes.
Answer 4: Renal artery bruits can be heard when renal artery stenosis is present.
Answer 5: Splenomegaly is usually associated with increased splenic workload, such as in hemolytic anemia.