Pancreatic Ca

Question 1

Where’s the most common location for pancreatic cancer

Answer 1

Head 60%
Body 25%
Tail 15%

Question 2

Risk factors for pancreatic ca

Answer 2

Smoking is most notable risk factor 
Heavy alcohol use
Chronic pancreatitis 
Diabetes
Obesity

Hereditary forms: 
HNPCC
Peutz Jeghers Syndrome 
BRCA 2
Cystic fibrosis
MEN II 
p53

Question 3

How does pancreatic CA present

Answer 3

Depends on the location of the tumour

Features of obstructive jaundice

Courvoisiers sign

If it spreads may have:
Direct spread to cbd(jaundice), duodenum(bleeding and obstruction) portal vein causing portal htn, ivc causing bilateral leg edema

To lymph nodes: sister Mary joseph , virchows

To liver causing Hepatomegaly

Constitutional symptoms

Question 4

Imaging study of choice for pancreatic ca?

Answer 4

Ct with contrast

Guides fNA
Determines how resectable tumour is
Detects regional and metastatic disease include nodes
Allows accurate determination of level of biliary obstruction

Question 5

Tumour markers for pancreatic ca

Answer 5

Ca 19-9
Cea
Alpha fetoprotein

Question 6

Curative treatment for pancreatic ca

Answer 6

Head of the pancreas:
Whipple: distal stomach, pancreatic head and neck, duodenum, cbd, hall bladder
Then do gastrojejunostomy

Mid body and tail:
Distal pancreatectomy with splenectomy with lymphadenectomy

Question 7

Palliative treatment of pancreatic ca

Answer 7

Endoscopic stents to bile duct and duodenum to relieve obstruction

Pain: opiates or celiac plexus block

Chemo: gemcitabine plus folfirinox