Carcinoma of the Pancreas

Question 1

What type of cancer is carcinoma of the pancreas?

Answer 1

Primary pancreatic ductal adenocarcinoma

Question 2

How early does a carcinoma of the pancreas metastasise and present?

Answer 2

Metastasizes early and presents late.

Question 3

What is this a presentation of?
Male, >70 years old, painless obstructive jaundice, palpable painless gallbladder (Courvoiser’s sign), epigastric pain, epigastric mass, hepatomegaly, ascites, anorexia, weight loss, diabetes, acute pancreatitis.

Answer 3

Carcinoma of the pancreas

Question 4

What are the risk factors for carcinoma of the pancreas?

Answer 4

1. Smoking, alcohol, diabetes mellitus, chronic pancreatitis, increased waist circumference.
2. 95% have mutations in the KRABS2 gene.

Question 5

How is carcinoma of the pancreas investigated?

Answer 5

1. Cholestatic jaundice
2. Increased CA19-9
3. USS, CT in suspicious USS (shows pancreatic mass/dilated biliary tree/hepatic metastasis)
4. Whipple’s procedure - pancreaticduodenectomy, if no lymph node involvement or metastases
5. Biopsy required for palliation
6. 80% need palliation of jaundice - stenting of CBD
7. Disabling pain needs high dose opioids

Question 6

What is Whipple’s procedure and what is it for?

Answer 6

1. Distal stomach, gallbladder, CBD, head of pancreas, duodenum, proximal jejunum and regional lymph node resection.
2. Carcinoma of the pancreas

Question 7

What is the most common site for carcinoma of the pancreas?

Answer 7

Head of the pancreas

Question 8

What is the prognosis for pancreatic carcinoma?

Answer 8

Dismal, mean survival <6 months.

Ampullary or Islet cell tumours confer better mortality.