Pancreatic Cancer Flashcards
State the incidence of Pancreatic Cancer.
Male = Female. 50% more than 75 years.
State the risk factors for Pancreatic Cancer.
Cigarette smoking. Diet rich in animal fat and red meat diet. Obesity. Family history. Chronic pancreatitis.
State a symptom of Pancreatic Cancer.
Dull epigastric pain (radiating to back) - worse when lying down. Jaundice (10% painless) - pale stool/dark urine. Weight loss. Sickness/indigestion. Diabetes. Blood clots - DVT. Change in bowel habit - steatorrhea.
State a sign of Pancreatic Cancer.
Jaundice. Palpable gallbladder - Courvoisier’s Law (non-tender, palpable gall bladder at night costal margin. Hepatomegaly/splenomegaly.
What might you find at right costal margin in Pancreatic Cancer?
Gall stones - repeated infection, fibrosis of gall bladder (BUT not palpable).
The intestine forms what from bilirubin?
Urobilinogen.
The liver reabsorbs urobilinogen and converts it into…
Urobilin.
What is excreted by the kidney and is yellow?
Urobilin.
Urobilinogen is reduced to what by the intestine?
Stercobilin.
What is excreted in faces by the intestine and is brown?
Stercobilin.
What happens to levels of stercobilin in faeces in Obstructive Jaundice?
Reduced stercobilin in faeces (pale stool).
What happens to levels of conjugated bilirubin in the blood in Obstructive Jaundice?
Increased level of conjugated bilirubin in blood.
Why is the urine dark in Obstructive Jaundice?
Increased level of conjugated bilirubin in blood.
Is Alanine Transferase and Aspartate Transferase Low or High in Obstructive Jaundice?
Low.
Is Alanine Transferase and Aspartate Transferase Low or High in Hepatitis?
High.
Is Alkaline Phosphatase Low or High in Hepatitis?
High.
Is Alkaline Phosphatase Low or High in Hepatitis?
Low.
State an investigation for Pancreatic Cancer.
FBC. Urea and Electrolytes. Liver Function Tests. Ca 19-9 (Pancreatic Tumour Marker).
State an imaging technique for Pancreatic Cancer.
CT scan. Transabdominal Ultrasound. ERCP (endoscopic retrograde cholangiopancreatography)/MRCP (magnetic resonance cholangiopancreatography).
Define a Transabdominal Ultrasound.
Ultrasound used to detect the degree of biliary tract dilation obstruction.
Define ERCP.
An Endoscopic Retrograde Cholangiopancreatography. Bendable, lighted tube used to examine pancreatic and bile ducts.
Define MRCP.
A Magnetic Resonance Cholangiopancreatography. Bendable, lighted tube used to examine pancreatic and bile ducts.
Define the T1 stage of Pancreatic Cancer.
Tumour inside the pancreas <2cm.
Define the T2 stage of Pancreatic Cancer.
2cm < size < 4cm in any direction.
Define the T3 stage of Pancreatic Cancer.
> 4cm in size.
Define the T4 stage of Pancreatic Cancer.
Involves nearby large blood vessels (not resectable usually).
Define the N0 stage of Pancreatic Cancer.
No lymph nodes spread.
Define the N1 stage of Pancreatic Cancer.
1 to 3 lymph nodes involved.
Define the M0 stage of Pancreatic Cancer.
No distant metastasis.
Define the M1 stage of Pancreatic Cancer.
Distant metastasis.
Define the Tx stage of Pancreatic Cancer.
Tumour cannot be assessed.
Define the T0 stage of Pancreatic Cancer.
No evidence of tumour.
Define the Tis stage of Pancreatic Cancer.
Carcinoma in situ.
State a surgery used for Pancreatic Cancer.
Pyloric Preserving Pancreatoduodenectomy (PPPD). Whipple’s Procedure. Total Pancreatomy.
What section is most likely to be resected in Pancreatic Cancer?
Head of the Pancreas.
What sections are least likely to be resected in Pancreatic Cancer?
Body. Tail. Presents late (spreads to lymph nodes or major blood vessels).
What happens in a Pyloric Preserving Pancreatoduodenectomy (PPPD)?
Head of the pancreas. Portion of the bile duct. Gall bladder. Part of the duodenum (1st part of SI).
Define Whipple’s Procedure.
Same as Pyloric Preserving Pancreatoduodenectomy (PPPD), but pyloric not preserved - all of duodenum removed.
Define Total Pancreatomy.
Pancreas removed. Stomach anastamosed to jejunum (2nd part of SI).
State the appearance of G1 (low grade pancreatic adenocarcinoma).
Low grade.
State the appearance of G3 or 4 (high grade pancreatic adenocarcinoma).
Abnormal cells - rapid growth/spread.
Most Pancreatic Cancers tend to be…
Exocrine adenocarcinomas (>80% ductal adenocarcinomas).
State an example of the occurrence of a rare Pancreatic Cancer.
Cystic tumours. Cancer of Acinar Cells (ends of ducts which produce digestive enzymes).
Define a stage 3 Pancreatic Adenocarcinoma.
Locally advanced cancer - involving surrounding tissues. Inoperable. Median survival (6 to 11 months).
Define a stage 4 Pancreatic Adenocarcinoma.
Cancer spreads to another part of body. Median survival (2 to 6 months). Varies depending how much the cancer has grown.
A third of endocrine pancreatic tumours produce what?
Hormones.
What does PNET stand for?
Pancreatic Neuroendocrine Tumours (PNETs).
Pancreatic Neuroendocrine Tumours (PNETs) are named after what?
The hormones they produce e.g. Gastrinoma, Insulinoma, VIPomas.
Two thirds of endocrine pancreatic tumours produce what?
They are non-functioning - no hormone production/no symptoms/most are malignant.
State one way how Pancreatic Neuroendocrine Tumours (PNETs) are graded.
Appearance of normal/abnormal cells. Mitosis count - Ki-67.
Define a well differentiated Pancreatic Neuroendocrine Tumour (PNET).
Low grade tumour < 20 mitoses. Ki 67 index < 20%.
Define a poorly differentiated Pancreatic Neuroendocrine Tumour (PNET).
High grade > 20 mitoses. Ki 67 index >20%. Rapid growth and spread.
State a symptom of Pancreatic Cancer.
Nausea, vomiting, fatigue. Weight loss from cancer-associated anorexia/malabsorption. Mid-epigastric pain (radiates to mid-lower back/worse when lying flat). Courvoisier’s sing (gall bladder enlarged and palpable). Troussean sign as malignant (blood clots felt as small lumps in skin).
Define a Carcinoid tumour.
It’s a subset of a neuroendocrine tumour that receives and sends messages through hormones to help body function. Type of slow growing cancer that can arise in several places (normally in enterochromaffin cells of stomach).
Define a Carcinoid crisis.
When the tumour outgrows the blood supply and mediators flood out (vasodilation, hypotension, tachycardia).
Where does a carcinoid tumour begin?
Appendix, ileum or rectum.
How is a carcinoid tumour treated?
Octreotide (somatostatin version) - to inhibit enterochromaffin cells.
