Carcinoma of the Pancreas Flashcards
Epidemiology of pancreatic cancer.
3% of all malignancies.
9000 deaths/yr in the UK
UK incidence is rising
Patients are often male and over 70
Risk factors of pancreatic cancer.
Smoking
Alcohol
Carcinogens
DM
Chronic pancreatitis
Increased waist circumference
POssibly a high-fat and red or processed meat diet.
Pathology of pancreatic cancer.
Mostly ductal adenocarcinoma - 60% arise the in head of pancreas, 25% in the body and 15% in the tail.
A few arise in the ampulla of Vater or pancreatic islet cells.
95% have mutations in the KRAS2 gene
Pancreatic islet cell cancers.
Insulinoma
Gastrinoa
Glucagonoma
Somatostatinoma
VIPoma
Clinical features of carcinoma of the pancreas
Painless obstructive jaundice (head)
Epigastric pain radiating to the back and relieved by sitting forward (body&tail)
Anorexia
Weight loss
Diabetes
Acute pancreatitis
Rare features of pancreatic cancer.
Thrombophlebitis migrans
Hypercalcaemia
Marantic endocarditis
Portal HTN
Nephrosis
Signs of pancreatic cancer.
Jaundice + palpable gallbladder
Epigastric mass
Hepatomegaly
Splenomegaly
Lymphadenopathy
Ascites
Investigations of pancreatic cancer.
Bloods - LFTs, FBC, CRP, ESR, Amylase, Check for cholestatic jaundice.
Imaging - CT or US, ERCP/MRCP, EUS
Biopsy
Imaging findings of pancreatic cancer.
Pancreatic mass +/- dilated biliary tree +/- hepatic metastases.
ERCP/MRCP can guide biopsy and help staging prior to surgery/stent insertion.
EUS (endoscopic sonography) is an emerging adjunct for diagnosis and staging.
Treatment of pancreatic cancer.
Surgery (Whipple’s procedure) only where no distant metastases are found.
Laparoscopic excision.
Post-op chemotherapy.
Pain relief
Palliation of jaundice