Malignant pancreatic cancers

Question 1

What are the risk factors for PDAC

Answer 1

High fat diet
Smoking
Chemical exposure
DM
Chronic pancreatitis
Family history

Question 2

What is the presentation of PDAC

Answer 2

• Early satiety
• Obstructive jaundice
• Unexplained weight loss
• Endoscopy negative epigastric/back pain
• Late-onset diabetes
• Signs of malabsorption without defined cause

Question 3

What are the investigations for PDAC

Answer 3

Blood tests
* May have normocytic, normochromic anemia
* Elevated serum bilirubin and ALP may confirm obstructive jaundice

Tumour markers
* No ideal marker
* CA 19-9 elevated in 50%

Question 4

Which imaging modalities will be used in PDAC

Answer 4

US
Contrast enhanced abdominal CT
MRI/MRCP
Endoscopic ultrasound
(PET scan)

Question 5

What is the management of PDAC

Answer 5

• Exclude red flags at presentation: most common cholangitis & pruritis
• Confirm and stage of tumor: CTAP
• Discuss at a multidisciplinary meeting
• Resectable: consider resection, ? need to drain jaundice
• Border line resectable: drain jaundice, neo- adjuvant chemotherapy
• Not resectable or metastatic: palliate

Question 6

Explain the different resections for PDAC

Answer 6

• Lesions in the head of the pancreas resected by pancreaticoduodenectomy.
• Lesions in the body and tail of the pancreas resected by distal pancreatectomy plus splenectomy.

Question 7

What are the different Pancreatic neuroendocrine tumors (PNET) functiona tumours

Answer 7

PNETs carcinoid, insulinoma
and gastrinoma are the most common.

Somatostatinoma
Glucagonoma
VIPoma
Pancreatic polypeptide

Question 8

Management of PNET

Answer 8

Slide 18 pancreas cancers