Snapshot A 65-year-old smoker has 20 lb weight loss over the last three months that is associated with epigastric pain after eating, diarrhea, and jaundice. PE reveals a palpable non-tender gallbladder and clay colored stool. Labs show a total bilirubin of 8, alkaline phosphatase of 450, and an ALT of 150. Introduction 90% are adenocarcinoma 60% in head More common in African Americans males cigarette linked to chronic pancreatitis and diabetes mellitus alcohol, gallstones, coffee are NOT risk factors Presentation Symptoms painless, extra-hepatic obstructive jaundice weight loss May have postprandial epigastric pain that is relieved by leaning forward diarrhea secondary to malabsorption Physical exam palpable gallbladder from obstructive distention migratory thrombophlebitis (10% - classic sign of Trousseau syndrome) patients should undergo abdominal computerized tomography (CT) scan left supraclavicular node palpable with metastatic disease Evaluation Labs increased bilirubin incrased alk phos increased CA19-9 not diagnostic but can be used to follow reponse to therapy mild anemia CT scan Ultrasound distended thin-walled gallbladder Treatment Head of pancreas Whipple procedure Body and tail Palliative treatment Prognosis, Prevention, and Complications Five year survival 5% after palliative resection