e. VIPoma i. Tumor produces vasoactive intestinal peptide (VIP)

ii. WD HA syndrome: watery diarrhea, hypokalemia, and achlorhydria 2. Pancreatic carcinoma a. Epidemiology i. Fifth most common cause of cancer death in the United States ii. Incidence is increasing iii. Most common between ages 60 and 80

iv. Risk factor: smoking b. Presentation i. Vague signs and symptoms until late in the course ii. Abdominal pain iii. Migratory thrombophlebitis iv. Obstructive jaundice c. Site: pancreatic head (60%), body (15%), and tail (5%)

d. Micro i. Adenocarcinoma arising from the duct epithelium ii. Tumor desmoplasia and perineural invasion are common e. Tumor markers: CEA and CA19-9

f. Treatment: surgical excision (Whipple procedure)

g. Prognosis: very poor; 1-year survival -10%

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