Pancreatic and Hepatobiliary Cancers | Clinical Medicine

What's up Ninja Nerds? In this video today we're going to be talking about pancreatic and hepatobiliary cancers. There's a bunch of different ones that we'll talk about.

We'll put a lot of emphasis primarily on two of them because you're going to see those most likely in your exams.

It's going to be the pancreatic carcinoma and we'll also talk about hepatocellular carcinoma.

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Without further ado, let's dig into the pathophys. Alright, so we're going to dig into pancreatic cancer first.

When we talk about this, it's one of those cancers that are very unfortunate.

I think Alex Trebek from Jeopardy was unfortunately diagnosed with pancreatic cancer and passed away because of it.

Rest in peace, my friend. But Steve Jobs is another one.

So those are something to consider, that these are cancers that can really plague patients.

And unfortunately, one of the problems with these is that they can be kind of clinically asymptomatic for a period of time until they get advanced.

And then usually at that point, that's when we kind of unfortunately see the really scary stuff that we'll talk about.

So with pancreatic cancer, I think the first thing to remember is where can it occur like in the pancreas? And you may think that's kind of like irrelevant, but not.

It really is important because the reason why is when you think about pancreatic cancer, it most often occurs in the pancreatic head.

So here we'll have the head, we have the body and the tail. It's pretty simple anatomy, right? Thankfully.

But usually that tumor is going to be most common in the head. And we'll kind of represent that here with like this blackish tumor here.

This is going to be the most common location. So the pancreatic head is going to be a really important one.

And I think when we talk about percentage-wise of how much that makes up of the locations,

you could probably say somewhere around like 60 to 70%.

So approximately somewhere around 60 to 70% of pancreatic cancers will occur in that location right there alone.

And this is unfortunate because this is what usually causes a lot of the really nasty symptoms, which we'll talk about.

Because if you know your basic anatomy and physiology, you know that the pancreatic head right here is where there's a couple different little spouts moving through.

You have the common bile duct. You compress that. You can get jaundice. You also can compress on the main pancreatic duct.

And unfortunately, that can potentially prevent pancreatic enzymes from getting into this area and bile.

So we can get a lot of complications that we'll talk about with that. Now, the other location is the pancreatic tail.

And this is going to be a very small percentage, but this is where the remainder of them usually occur.

And when we talk about this, it maybe accounts for like, I'd say 20 to 30 percent. So somewhere within that residual amount.

And you're probably like, okay, there's still some left over. Where would that be? That's usually in the body.

But most often, these are going to be the two most common locations.

Now, the reason why I mention this one is because the pancreatic tail is near. Guess what organ? The spleen.

And so oftentimes when we have to do surgeries, which we'll talk about them in the treatment section, whenever you have to remove a pancreatic tumor, sometimes you have to remove a lot of other associated tissue, such as the duodenum.

And unfortunately, whenever you remove the pancreatic tail tumor, sometimes you may even have to consider removing the spleen as well.

So we'll talk about this. It's called a Whipple here, and this is just going to be a distal tail resection, but you may have to include the spleen in that. So it's really important to think about these things.

Now, the next step I want to say is, okay, this is the location-wise of where they'll occur.

But if you actually kind of zoom in and kind of take it at the microscopic level, you're like, bro, Zach, we're going a little deep here, aren't we?

No, I think it's important because I think it kind of gives us a little bit of understanding of the classic findings, the complications, things like that.

So when we take and kind of zoom in just in this area, you'll see this kind of structure here.

So this is going to be your pancreatic ductal system, right? So all of these, I'll kind of, I'll write those out, but we're going to call these just your pancreatic ducts.

and then here are going to be your assinai, and then right here we're going to call these the islets of Langerhahn.

I bet you remember those, right? So islets of Langerhahn are important because they are different as compared to these other two structures up here.

So pancreatic ducts, we've got a couple of these. We'll kind of bring these two together, right?

And then here's the assinai, and then here's your islets of Langerhahn. And it consists of some different cells in there.

You have the pancreatic alpha cells, the pancreatic beta cells, you get the PP cells, you have the delta cells. There's all these different types of cells.

But the important thing to remember is the pancreatic ducts in the asinine make up the exocrine portion of the pancreas.

That controls the digestive juices, the enzymes, whereas the alex of Langerhans make up the endocrine portion of the pancreas.