Pancreatic cancer Flashcards
What is pancreatic cancer?
Malignancy arising from the endocrine or exocrine tissues of the pancreas.
What are the causes of pancreatic cancer? (x2)
o 5-10% familial including BRCA2 mutation, familial atypical multiple mole melanoma (CDKN2A), Peutz-Jeghers (STK11/LKB1), hereditary pancreatitis (PRSS1).
o Precursor lesion including pancreatic intraductal neoplasia and intraductal pancreatic mucinous neoplasm.
o Otherwise UNKNOWN.
What are the risk factors of pancreatic cancer? (x6)
Smoking, alcohol, diabetes, chronic pancreatitis, obesity, high fat and red/processed meats in diet.
What is the epidemiology of pancreatic cancer: Incidence? Trend? Deaths? Gender? Age?
8-12/100 000. Increasing incidence. Worldwide 8th cause of cancer death. 2:1 male: female. Peak age 60-80 years.
What are the symptoms of pancreatic cancer? (x6)
o Initial symptoms are non-specific
o Anorexia
o Malaise
o Weight loss
o Nausea
o Later, jaundice and epigastric pain
What are the signs of pancreatic cancer? (x10)
o Weight loss
o Epigastric tenderness
o Epigastric mass
o Painless jaundice and palpable gallbladder (Courvoisier’s law)
o Hepatomegaly when there are metastases
o History of recent but unexplained blood vessel inflammation caused by blood clots (thrombophlebitis) known as Trousseau sign
o Recent onset of labile diabetes
o Hypercalcaemia
o Ascites
What is Courvoisier’s law?
Patient with painless jaundice and an enlarged gallbladder – cause is unlikely to be gallstones and therefore the cause should be presumed as an obstructing pancreatic or biliary neoplasm until proven otherwise.
What is the pathogenesis of pancreatic cancer: Where? Types? Spread?
Most occur within the head or neck of the pancreas where it can present as a periampullary tumour (near ampulla of Vater). Most are adenocarcinomas, though other types include adenosquamous, mucinous cystadenocarcinomas, insulinomas, glucagonomas and gastrinomas. Spread is to liver.
What are the investigations for pancreatic cancer? (x8)
o BLOODS: tumour markers CA19-9 and CEA can be elevated. Increased bilirubin, ALP and clotting may be deranged if causing obstructive jaundice (periampullary may affect CBD).
o ENDOSCOPIC USS: to confirm diagnosis and resectability
o CT: to confirm diagnosis and resectability
o FINE NEEDLE ASPIRATION: often endoscopic USS guided, when there is diagnostic uncertainty
o ERCP: allow biopsy or bile cytology +/- stenting if the tumour is obstructive
o MRI, PET and laparoscopy: for staging
What are the complications of pancreatic cancer? (x10)
Obstructive jaundice, duodenal obstruction, acute pancreatitis, pruritus (unpleasant itching of skin), cholangitis, diabetes, splenic vein thrombosis, malignant ascites, marantic endocarditis, nephrosis (renal vein metastases).
What causes pruritus in pancreatic cancer?
Build-up of bilirubin.
What does splenic vein thrombosis lead to?
Portal vein hypertension.
