Pancreatic Cancer Flashcards
Define Pancreatic Cancer
Malignancy arising from the exocrine or endocrine tissues of the pancreas
Aetiology of Pancreatic Cancer
Primary pancreatic ductal adenocarcinoma (>85% of all pancreatic neoplasms)
75% within head or neck of pancreas
Unknown cause, 5-10% inherited component
Inherited - pancreatitis, Peutz-Jeghers syndrome, HNPCC syndrome, familial breast cancer and multiple mole melanoma
Risk factors for pancreatic cancer
Older age Cigarette smoking Family history Hereditary cancer syndromes Chronic sporadic pancreatitis Obesity Dietary factors e.g. high alcohol intake, high meat and fat, low serum folate levels
Epidemiology of pancreatic cancer
Disease of older age (peak 65-75)
1/3 most common cause of cancer-related death in the US
Symptoms of Pancreatic Cancer
Jaundice Upper abdominal pain or discomfort Weight loss and anorexia Steatorrhoea (pale stools, dark urine) Thirst, polyuria, nocturia (consider pancreatic cancer in new-onset diabetes with no FMH or predisposing factors) Nausea and vomiting Petechiae, purpura, bruising
Signs of Pancreatic Cancer on examination
Signs of weight loss Epigastric tenderness or mass Jaundice Palpable gallbladder (Courvoisier's law) Hepatomegaly (metastatic spread)
Trousseau’s sign - superficial thrombophlebitis (Inflate BP cuff, observe for 2-3 minutes for carpopedal spasm involving flexion of the wrist, thumb, and MCP joints + hyperextension of the IP joints)
Investigation for Pancreatic Cancer
Pancreatic CT: mass in the pancreas and extent of local or distant spread
Tumour markers: CA 19-9 elevated
LFTs: ALP/GGT raised, ALT/AST mildly raised, bilirubin elevated)
FBC: thrombocytopenia, anaemia
Clotting: PT prolongation
U+Es: hypocalcaemia
USS: pancreatic mass, dilated bile ducts, liver mets
PET: if CT is unclear
ERCP: ampullary tumour
MRCP: ?duct involvement -> double duct sign
