Editing Periampullary cancer (section)

== Four common types: ==

=== '''Pancreatic ductal adenocarcinoma (~80%)''' ===

** Also most aggressive of these - only 15% of patients are surgical candidates at diagnosis
** Among those who have surgery, median survival is 20 months, and 5 year survival of 20%
** Commonly 50-70yo
** RFs:
*** Smoking
*** Obesity
*** T2DM
*** Family history

=== '''Distal cholangiocarcinoma (~10%)''' ===

** Distal CCA arises in CBD between junction of cystic duct and ampulla of Vater
** RFs:
*** 60-70yo
*** PSC
*** Parasites
*** CP
*** HBV/HCV
*** Choledochal cysts
** 5 year survival: 30% for local/regional disease, 2% for distant mets at time of diagnosis

=== '''Ampullary adenocarcinoma''' ===

** Generally develop obstructive symptoms early, and therefore seen earlier
** 80% resectable disease
** There could be two different subtypes - intestinal (better) and pancreaticobiliary (worse survival)

=== '''Duodenal adenocarcinoma''' ===

** Often quite large at diagnosis, because they can have unrestricted growth before symptoms are noted
* Rarely - neuroendocrine neoplasms, pancreatic cystic neoplasms, acinar and squamous cell carcinomas, GI stromal tumours, sarcomas, lymphomas, metastases.