Carcinoma of the Pancreas Flashcards
What is the most common type of pancreatic cancer?
- Adenocarcinoma
- Arises from glandular duct cells that line ducts of exocrine system
Who is pancreatic adenocarcinoma common in?
- Elderly males
- Very little is known about underlying cause
- Smoking is only well recognised risk factor
Most pancreatic adenocarcinomas involve the head of the pancreas. What do they present with?
-
Obstructive, painless jaundice
- tumour compresses common bile duct as it passes through the head of pancreas so that bile is unable to drain into duodenum
- other features: weight loss, mid-epigastric pain (often radiating to back)
- palpable gallbladder
- loss of exocrine fxn (steatorrhoea)
- loss of endocrine fxn (diabetes)
- Trousseau’s sign (hand spasm w/ BP cuff inflation)
What investigations are performed for pancreatic cancer?
- USS
- high-res CT investigation of choice if diagnosis suspected
What is the treatment for majority of pancreatic carcinoma patients?
- 80% of pts with pancreatic carcinoma have advanced disease (high stage) at time of dx
- treatment is palliative
- palliative treatment options:
- chemotherapy
- stenting the common bile duct to relieve jaundice
- optimising symptom control
A minority of pancreatic carcinoma patients (20%) are suitable for curative surgery - Why are they suitable? What is the procedure called?
- bc tumour appears to be confined to pancreas and lymph nodes are not involved
- Whipple’s procedure
What happens in a Whipple’s procedure?
The distal stomach, gallbladder, common bile duct, head of pancreas, duodenum, proximal jejunum and regional lymph nodes are resected.
Reconstruction restores intestinal fxn by re-establishing flow of pancreatic juices, bile and food along GI tract.
What is the 5 year survival following a) curative surgery (Whipple’s) and b) overall survival for pancreatic cancer?
A) Whipple’s - 20-40%
B) 5% (incl majority of pts who have advanced disease)
