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Gwen - GI and General surgery > Hepato-biliary: Pancreatic cancer > Flashcards

Hepato-biliary: Pancreatic cancer Flashcards

1
Q

What sex does pancreatic carcinoma occur more commonly in?

A

Male

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2
Q

What age range does pancreatic cancer most commonly occur in?

A

60-80 years old

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3
Q

What are risk factors for developing pancreatic cancer?

A
  • Smoking
  • Alcohol
  • Carcinogens
  • Diabetes mellitus
  • Chronic pncreatitis
  • Increased waist circumference
  • High fat/red/processed meat diet
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4
Q

What genes are linked to pancreatic cancer?

A

HNPCC

MEN

BRCA2 gene

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5
Q

What type of carcinoma is most common in the pancreas?

A

Adenocarcinoma arising from ductal epithelial cells

(Others - carcinosarcoma, cystadenocarcinoma, acinar cell)

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6
Q

Describe the pathogenesis of pancreatic cancer?

A

Cancer originates in the ductal epithelium and evolves from premalignant lesions to fully invasive cancer. The lesion called pancreatic intraepithelial neoplasia (PanIN) is the best-characterized histologic precursor of pancreatic cancer.

There is progression from minimally dysplastic epithelium (PanIN grades 1A and 1B) to more severe dysplasia (grades 2 and 3)

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7
Q

What proportion of pancreatic cancers arise in the head of the pancreas?

A

75%

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8
Q

What are the main types of pancreatic cancer?

A
  • Adenocarcinoma
  • Carcinosarcoma
  • Cystadenocarcinoma
  • Acinar cell carcinoma
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9
Q

What proportion of pancreatic cancers arise from the body of the pancreas?

A

25%

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10
Q

What genetic mutation is very commonly found in people with pancreatic cancer?

A

KRAS2

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11
Q

What are symptoms of cancer in the head of the pancreas?

A

ASYMPTOMATIC EARLY STAGES

  • Painless obstructive jaundice - can affect CBD
  • Weight loss
  • Sympatomatic episodes of pancreatitis
  • Symptoms of diabetes - polyuria, polydipsia, thirst
  • Itching
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12
Q

What symptoms might you find in pancreatic cancers of the pancreatic body or tail?

A
  • Upper abdominal pain - can radiate tot he back, partial relief sitting forward (greater nerve endeings)
  • Weight loss/anorexia
  • Fatigue
  • Diarrhoea/Steatorrhoea
  • Nausea/vomiting
  • DM may occur
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13
Q

What are general signs that someone might have pancreatic cancer?

A
  • Jaundice + painless palpable gall bladder (Courvoisier’s sign)
  • Epigastric mass
  • Hepatomegaly
  • Splenomegaly
  • Lymphadenopathy
  • Ascites
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14
Q

What is courvoisier’s sign?

A

In a jaundiced patient, the combination of a non-tender, distended gallbladder and obstructive jaundice is taken to indicate a non-calculous obstruction of the common bile duct.

It is commonly said to be a sign of obstruction to the biliary system by malignancy.

Ie if the gallbladder is papable and jaundice is present its unliekly to be gallstones

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15
Q

What conditions is courvoisier’s sign most commonly seen in?

A
  • Cholangiosarcoma
  • Cancer of the head of the pancreas
  • Cholelithiasis – uncommon
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16
Q

Why does courvoisiers sign happen?

A

Thought to be that chronic obstruction of the biliary system and/or gallbladder leads to higher biliary duct pressure over a long period of time and does not provide the acute distension that usually causes inflammation and pain. Malignant causes of obstruction are more likely to provide chronic distension.

17
Q

What are rare features that can manifest in pancreatic cancer?

A
  • Thrombophlebitis migrans
  • Maranatic endocarditis
  • Portal hypertension
  • Nephrosis
  • Hypercalcaemia
18
Q

What tumour marker is linked to pancreatic cancer?

A

CA19-9

19
Q

If you suspected pancreatic carcinoma, what investigations would you consider doing?

A
  • Bloods - CA 19-9, LFTs
  • CXR
  • Abdominal US (shows dilated bile ducts and mass)-> CT Scan (more sensitive, especially for body and tial tumours and staging of tumours) +/- EUS to confirm
  • Percutaneous needle biopsy
  • CT/PET for staging
20
Q

If someone had features of pancreatic cancer and pulmonary symptoms, what might this indicate in terms of severity of disease?

A

Advanced disease

21
Q

Which part of the pancreas would you be thinking is affected by cancer if courvoisiers sign was present?

A

Head of the pancreas - also present with itch due to cholestasis

22
Q

What tumour marker can be used to diagnose and monitor pancreatic cancer?

A

CA19-9

23
Q

How would you manage pancreatic cancer?

A

Most ductal tumours present with metastatic disease

  • CURATIVE: Radical surgery- pancreatoduodenectomy (Whipple’s procedure) - removes pancreatic head
    • Patient is fit, Tumour <3 cm diameter, No metastases
  • PALLIATIVE: Palliation of jaundice
    • Stent (ERCP)
    • Palliative surgery - cholechoduodenostomy
  • Pain control - opiates, coeliac plexus block, radiotherapy
24
Q

What methods are used for pain control in pancreatic cancer?

A
  • Opiates
  • Coeliac plexus block
  • Radiotherapy
25
Q

What palliative interventions are used in pancreatic cancer?

A
  • Endoscopic/percutaneous stent
  • Bypass surgery - cholechoduodenostomy
26
Q

What is the mean survival for those with pancreatic cancer?

A

Mean survival < 6 months

27
Q

What is whipple’s procedure?

A

A complex operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct. The Whipple procedure is used to treat tumors and other disorders of the pancreas, intestine and bile duct

28
Q

What surgical procedures are used to resect cancers in the tail of the pancreas?

A
  • Distal Pancreatectomy
  • Total Pancreatectomy (Whipple’s)
29
Q

What procedures can be used to relieve jaundice in someone with inoperable pancreatic cancer?

A

Internal biliary stent placed by ERCP/PTC

30
Q

What surgical procedures can be used to treat gastric outlet obstruction in inoperable cases of pancreatic cancer?

A
  • Duodenal stent
  • Laparoscopic Gastrojejunostomy
31
Q

What is pancreatitis assocaited with?

A

Chronic pancreatitis

DM

Smoking

32
Q

Prognosis chronic pancreatitis

A

If operable - 15% 5 year survival

If inoperable - mean survival <6 months

Gwen - GI and General surgery (44 decks)

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