Challenge Your Exam Readiness With Our Free USMLE Practice Questions

Pancreatic adenocarcinoma commonly arises in the head of the pancreas and presents with painless jaundice (biliary obstruction), weight loss, and a palpable, nontender gallbladder or epigastric mass (Courvoisier sign). Risk factors include chronic alcohol use, chronic pancreatitis, smoking, diabetes, and family history. Elevated bilirubin and alkaline phosphatase suggest cholestasis due to obstruction of the common bile duct. Gastric carcinoma typically presents with epigastric discomfort, anemia, or weight loss but not obstructive jaundice. Hepatocellular carcinoma arises in the setting of cirrhosis or hepatitis B/C, presenting with liver mass and elevated alpha-fetoprotein. Cholangiocarcinoma is a bile duct malignancy associated with primary sclerosing cholangitis, often presenting with jaundice but less likely to cause a firm pancreatic head mass. Diagnosis of pancreatic cancer often involves CT or MRI of abdomen, CA 19-9 marker, and biopsy confirmation. Prognosis is poor; surgical resection (Whipple procedure) is the only curative option in localized disease, but many present late. Palliative care may include stenting for biliary obstruction and systemic chemotherapy.