Intra-abdominal cancer

Question 1

Most common type of pancreatic cancers:

Answer 1

Over 80% of pancreatic tumours are adenocarcinomas which typically occur at the head of the pancreas.

Question 2

What are the risk factors for pancreatic cancer?

Answer 2

increasing age
smoking
diabetes
chronic pancreatitis 
HNPCC/FAP
multiple endocrine neoplasias
BRCA2 gene
Peutz–Jeghers syndrome and ataxia-telangiectasia

Question 3

Presenting symptoms of pancreatic cancer:

Answer 3

Classically painless jaundice

Courvoisier’s law states that in the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones
Non-specific presentation - anorexia, weight loss, epigastric pain
Loss of exocrine function (e.g. steatorrhoea)
Loss of endocrine function (e.g. diabetes mellitus)
Atypical back pain is often seen
Migratory thrombophlebitis (Trousseau sign) is more common than with other cancers

Question 4

Investigations done to diagnose pancreatic cancer:

Answer 4

ultrasound has a sensitivity of around 60-90%

high-resolution CT scanning is the investigation of choice if the diagnosis is suspected

Question 5

Management of pancreatic cancer:

Answer 5

Less than 20% are suitable for surgery at diagnosis
Whipple’s resection (pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas. Side-effects of a Whipple’s include dumping syndrome and peptic ulcer disease
Adjuvant chemotherapy
ERCP with stenting is often used for palliation

Question 6

Which genes are associated with pancreatic cancer?

Answer 6

HNPCC
FAP
BRCA2 gene