Carcinoma of the Pancreas.
Etiology.—The disease occurs most frequently in men past forty years of age, although one case has been recorded in a child of two years, and in one at birth. While it may be primary, it is generally secondary. The primary cause is entirely unknown.
Pathology.—The scirrhus form is the one most commonly found, although the softer varieties are sometimes seen. The disease may be primary or secondary, usually the latter, and may involve any part of the organ, the head being the most common seat of the growth, which varies in size from that of a pigeon's egg to that of a child's head. Extension to adjacent organs frequently takes place, and adhesions to the stomach, colon, liver, intestine, spleen, gall-bladder, or peritoneum, are not uncommon.
Where the head of the pancreas is principally involved, the obliteration of Wirsung's duct may give rise to retention-cysts, or, by occluding the common bile-duct, the gall-bladder becomes distended with colorless fluid.
Symptoms.—The symptoms vary according to the stage of the disease, the portion involved, the extent of the metastasis, and pressure effects. It is difficult to separate the symptoms of one stage from the other; hence, the symptoms are not sufficiently pronounced to make them characteristic.
Disturbances of digestion are generally first noticed. The patient has noticed that he has been losing flesh and strength, that the appetite is poor, and that there is distress after eating, a sense of fullness in the epigastrium, attended by heart-burn, eructation, nausea, and occasional vomiting. There is a deep-seated pain of a burning or boring character.
The patient becomes anemic, and has a cachectic appearance. The stools are greasy and sometimes bloody. A large amount of undigested muscular fibers in the stools, shows defective pancreatic digestion.
Where the head of the pancreas is chiefly involved, there is pressure upon the common bile-duct, with persistent jaundice. When the portal veins are compressed, ascites follows. The stools are very large, considering the amount of food taken, and should excite suspicion as to the nature of the disease. Should the inferior vena cava be compressed by the encroachment of the growth, dropsy of the lower extremities takes place, and should the intestine be involved, stenosis may follow, with irremediable constipation. The emaciation increases each day, cachexia becomes more pronounced, and the tumor mass may be felt through the thin abdominal walls.
The urine is generally albuminous, and glycosuria is not uncommon.
Diagnosis.—Where a patient presents rapid emaciation, persistent jaundice, deep-seated epigastric pain, a tumor mass, muscular fibers in the stools without diarrhea, fatty stools, and albumin and sugar in the urine, cancer of the pancreas is rightly suspected.
Prognosis.—Carcinoma of the pancreas, like that of any of the viscera, is necessarily fatal.
Treatment.—This is only palliative. Narcotics will be used to the extent of giving relief. The pancreatic preparations will be given in the hopes of aiding digestion. The food will be of the most nourishing character, and that which is easily assimilated. Itching of the skin is one of the most annoying features, and demands attention.
"Washing the skin with dilute vinegar, a teaspoonful to a quart of the decoction of the bran of almonds, or weak carbolic acid solution, one to two per cent, or rubbing with fresh lemon-peel, or spraying with from one per cent to two per cent of salicyl-alcohol, or one per cent of menthol alcohol, is beneficial." (Osler.)
Washing with as much hot water as can be borne will sometimes give relief. Where the itching persists despite these precautions, morphia, hypodermically, should be used to obtain relief.