4.3. Pancreatic Disease - Carcinoma of the Pancreas Flashcards
What is happening to the Incidence of Pancreatic Carcinoma?
It is increasing
Is Pancreatic Carcinoma more common in Males or Females?
Males
In what age group is Pancreatic Carcinoma most commonly found?
60-80 year olds
What are risk factors for Pancreatic Cancer?
- Smoking
- Excessive Alcoholism
- Excessive intake of Coffee and Aspirin
What types of Pancreatic Carcinoma are there?
- Duct Cell Mucinous Adenocarcinoma (75% of cases)
- Acinar Cell Adenocarcinoma (5% of cases)
- Carcinosarcoma (Rare)
- Cystadenocarcinoma (Rare)
What causes the Dysplasia of Pancreatic Cells?
Successive Accumulation of Gene Mutations
In what sites do Duct Cell Mucinous Adenocarcinoma (DCMA’s) occur?
- The Head of the Pancreas (60% of DCMA’s)
- The Body of the Pancreas (13% of DCMA’s)
- The Tail of the Pancreas (5% of DCMA’s)
- Multiple Sites (22% of DCMA’s)
Where does the Pancreatic Cancer originate?
The Ductal Cell Epithelum
What does the Pancreatic Carcinoma evolve from / to?
From - Premalignant Lesion
To - Fully Invasive Cancer
What are the Clinical Signs of Pancreatic Carcinoma in the Head of the Pancreas?
- Jaundice
- Scratch Marks
- A Palpable Gallbladder and Cholestatic Signs
- A Palpable Mass
- Thrombophlebitis Migrans
What are the Clinical Signs of Pancreatic Carcinoma in the Body / Tail of the Pancreas?
- None (Most common)
- Thromboembolic Phenomina / Polyarthiritis
- Skin Nodules
- Lymphadenopathy
What causes the Jaundice / Palpable Gallbladder and Cholestatic Signs in Carcinoma of the Head of the Pancreas?
The Carcinoma Obstructing the Common Bile Duct
What causes the Dermatological Scratch Marks / Hepatomegaly occur in Carcinoma of the Head of the Pancreas?
These are Secondary to Cholestatic Symptoms - Due to the Liver Dysfunction and Hyperbilirubinaemia
What is Thrombophlebitis Migrans? And why does it occur in Carcinoma of the Head of the Pancreas?
A Migrating Vein Inflammation due to the potential of portal hypertension
Why does Thromboembolic Phenomina / Polyarthiritis occur in Carcinoma in the Body / Tail of the Pancreas?
This is not fully understood
Why do Skin Nodules appear in Carcinoma in the Body / Tail of the Pancreas?
These are secondary to the Localized Fat Necrosis and the associated Inflammation
Which Lymph Node involvement suggests Aggressive Carcinoma in the Body / Tail of the Pancreas?
Supraclavicular Lymphadenopathy
What are the Symptoms caused by Pancreatic Carcinoma?
- Painless (Pain may arise in Late-Stage)
- Pancreatitis Symptoms
- Steatorrhoea
- Epigastric Pain
- Weight Loss
- Fatigue
Why might Pancreatitis Symptoms occur in Pancreatic Carcinoma?
Symptomatic Episodes of Pancreatitis may be associated with the Blockage of the Pancreatic Duct
Why might Weight Loss / Steatorrhoea occur in Pancreatic Carcinoma?
Due to the Malabsorption caused by the associated Exocrine Deficiency of Pancreatic Carcinoma
What can relieve the Epigastic Pain associated with a Pancreatic Tumour of the Body of the Pancreas?
Leaning forward
What is the Order of Investigations which occur with Clinical Suspicion of Pancreatic Carcinoma?
- (Abdominal / Endoscopic) Ultrasound / CT Scan
2a) For Jaundice with a Mass - ERCP + Stenting
2b) For Jaundice without a Mass - Endoscopic Ultrasound / Percutaneous Needle Biopsy
Note - 2a is followed by 2b - After the Carcinoma has been diagnosed - CT Scan / Endoscopic Ultrasound / Laparoscopy - to determine if the Cancer is Operable
What is a Laparoscopy?
A Fibre-Optic Instrument inserted through the Wall of the Abdomen to view the External Pancreas
What is the treatment of the Pancreatic Carcinoma?
- Whipples Procedure (Pancreatoduodenectomy)
- Cholechoduodenostomy
- Palliative Care
What percentage of Pancreatic Carcinoma’s are operable?
Less than 10%
What does Whipples Procedure (Pancreatoduodectomy) involve?
This Radical Surgery involves the removal of both the Pancreas and the Duodenum
Who can Whipples Procedure (Pancreatoduodenectomy) be done on?
- If the patient is fit
- If there is no Metastases
- If the Tumour is less than 3cm in diameter
What is a Cholechoduodenostomy?
The anastomosis of the Common Bile Duct, to relieve symptoms - this is palliative surgery
What does Palliative care involve?
- Opiates / Coeliac Plexus Block - For Pain relief
- Stenting - For Symptomatic Relief of Cholestasis Symptoms
- Radiotherapy / Chemotherapy - to alleviate some symptoms
What is the Survival Rate of Inoperable Cases?
1% 1 year survival
Mean Survival = 6 months
What is the Survival Rate of Operable Cases?
15% 1 year survival
