CAKCINOMA OF THE PANCREAS. 419 



part of the gland, retroperitoneal extension may occur, the cyst 

 invading the lumbar region. 



Pancreatic cysts, from their position, may transmit the pulsation 

 of the aorta, or compress the inferior vena cava or the portal 

 vein. They have been known to cause obstruction of the small 

 bowel. They must be distinguished from encysted fluid in 

 the lesser sac of the peritoneum, such as may result from 

 crushing of the pancreas against the vertebral column. 



Carcinoma of the Pancreas. Since the head of the pancreas 

 is the usual seat of cancer in this organ, pressure symptoms are 

 pronounced. The intimate relation of the common bile duct to 

 the head of the gland accounts for its early obstruction with the 

 production of jaundice, distension of the gall bladder, swelling of 

 the liver from retained bile, and rarely, attacks of colic indis- 

 tinguishable from those due to gall stones. The infiltrated pan- 

 creas is not easily felt, and is usually concealed by the distended 

 gall bladder. Occasionally, however, it can be recognised as a deep- 

 seated tumour above the umbilicus, for it lies in front of the 

 second lumbar vertebra, whilst the umbilicus corresponds to the 

 body of the fourth. The tumour may transmit the pulsations of 

 the aorta, which lies behind it, and may ultimately give rise to com- 

 pression of the portal vein, the splenic vein, or the inferior vena 

 cava, all of which are also in posterior relation with the gland. 

 Ascites, swelling of the spleen, or dropsy of the legs and lower part 

 of the abdomen, may thus be produced. The intimate relation of 

 the duodenum to the head of the pancreas accounts for the occasional 

 invasion of this part of the bowel. The transverse colon which 

 crosses the head of the pancreas, is sometimes infiltrated. The 

 pylorus also is not far distant from the head of the gland, but it 

 is more common for cancer of the pylorus to become adherent 

 to the pancreas than for cancer of the pancreas to invade the 

 pylorus. The cancer being in portal territory secondary growths 

 may be expected in the liver, but the patient often dies before 

 metastasis occurs. The chain of lymphatic glands along the 

 pancreas also becomes involved. When malignant disease 

 invades the tail of the pancreas, which is uncommon, it is not 



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