When the disease is still in an early stage (AJCC-UICC stages I and II), without spread to large blood vessels or distant organs such as the liver or lungs, surgical resection of the tumor can normally be performed, if the patient is willing to undergo this major operation and is thought to be sufficiently fit.The AJCC-UICC staging system allows distinction between stage III tumors that are judged to be "borderline resectable" (where surgery is technically feasible because the celiac axis and superior mesenteric artery are still free) and those that are "unresectable" (due to more locally advanced disease); in terms of the more detailed TNM classification, these two groups correspond to T3 and T4 respectively. Pancreatic cancer staging (TNM classification)
		
		
		
		
		

Locally advanced adenocarcinomas have spread into neighboring organs, which may be any of the following (in roughly decreasing order of frequency): the duodenum, stomach, transverse colon, spleen, adrenal gland, or kidney. Very often they also spread to the important blood or lymphatic vessels and nerves that run close to the pancreas, making surgery far more difficult. Typical sites for metastatic spread (stage IV disease) are the liver, peritoneal cavity and lungs, all  of which occur in 50% or more of fully advanced cases. PanNETs
The 2010 WHO classification of tumors of the digestive system grades all the pancreatic neuroendocrine tumors (PanNETs) into three categories, based on their degree of cellular differentiation (from "NET G1" through to the poorly differentiated "NET G3").
Low-set ears are a clinical feature in which the ears are positioned lower on the head than usual. They are present in many congenital conditions. Low-set ears are defined as outer ears positioned two or more standard deviations lower than the population average. Clinically, if the point at which the helix of the outer ear meets the cranium is at or below the line connecting the inner canthi of eyes(bicanthal plane), the ears are considered low set.Low-set ears can be associated with conditions such as:

Down syndrome
Turner syndrome
Noonan syndrome
Patau syndrome
DiGeorge syndrome
Cri du chat syndrome
Edwards syndrome
Fragile X syndrome
Okamoto syndromeIt is usually bilateral, but it can be unilateral in Goldenhar syndrome. See also
LEOPARD syndrome

References


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