Carcinoma of the Pancreas Flashcards

1
Q

Epidemiology of pancreatic cancer.

A

3% of all malignancies.

9000 deaths/yr in the UK

UK incidence is rising

Patients are often male and over 70

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2
Q

Risk factors of pancreatic cancer.

A

Smoking

Alcohol

Carcinogens

DM

Chronic pancreatitis

Increased waist circumference

POssibly a high-fat and red or processed meat diet.

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3
Q

Pathology of pancreatic cancer.

A

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

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4
Q

Pancreatic islet cell cancers.

A

Insulinoma

Gastrinoa

Glucagonoma

Somatostatinoma

VIPoma

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5
Q

Clinical features of carcinoma of the pancreas

A

Painless obstructive jaundice (head)

Epigastric pain radiating to the back and relieved by sitting forward (body&tail)

Anorexia

Weight loss

Diabetes

Acute pancreatitis

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6
Q

Rare features of pancreatic cancer.

A

Thrombophlebitis migrans

Hypercalcaemia

Marantic endocarditis

Portal HTN

Nephrosis

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7
Q

Signs of pancreatic cancer.

A

Jaundice + palpable gallbladder

Epigastric mass

Hepatomegaly

Splenomegaly

Lymphadenopathy

Ascites

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8
Q

Investigations of pancreatic cancer.

A

Bloods - LFTs, FBC, CRP, ESR, Amylase, Check for cholestatic jaundice.

Imaging - CT or US, ERCP/MRCP, EUS

Biopsy

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9
Q

Imaging findings of pancreatic cancer.

A

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.

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10
Q

Treatment of pancreatic cancer.

A

Surgery (Whipple’s procedure) only where no distant metastases are found.

Laparoscopic excision.

Post-op chemotherapy.

Pain relief

Palliation of jaundice

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