See DIABETES MELLITUS.

The incidence of pancreatic cancer is rising: around 7,600 cases are now diagnosed annually in the UK, accounting for 1–2 per cent of all malignancies. There is an association with heavy cigarette-smoking, OBESITY, and chronic PANCREATITIS, while it is twice as common in patients with DIABETES MELLITUS as compared with the general population. Treatment depends on the stage the cancer has reached (see TNM CLASSIFICATION). Discrete localised tumours are treated surgically. PALLIATIVE surgery might also be recommended if there are unpleasant symptoms, for example due to obstruction of the bile duct. Chemotherapy with gemcitabine or fluorouracil might also be offered.

may be painless; it leads to pancreatic failure causing MALABSORPTION SYNDROME and diabetes mellitus, and the pancreas becomes calcified with shadowing on X-RAYS. The malabsorption is treated by a low-fat diet with pancreatic enzyme supplements; the diabetes with insulin; and pain is treated appropriately. Surgery may be required.

An uncommon disease but a common cause of emergency admission to hospital because of the severity of pain. This may start gradually or suddenly together with vomiting. There is a wide spectrum of consequences, from recovery within a few days to severe organ failure with fever, TACHYCARDIA, and low blood pressure; the worst affected patients go into SHOCK and may die. The commonest causes are gallstones, and alcohol dependency; rarer causes are as a side-effect of certain drugs (see AZATHIOPRINE and DIURETICS) and infections such as MUMPS. In 10% of patients, no cause can be found. The diagnosis is made on the clinical history and confirmed by finding the blood concentrations of AMYLASE and LIPASE are raised by more than three times the usual limit. Where the tests are equivocal, contrast enhanced CT scanning may be used. Treatment includes intensive care support if necessary, intravenous feeding, ANTICHOLINERGIC drugs and ANALGESICS.