Pancreatic Cancer Flashcards

1
Q

List 4 risk factors for pancreatic cancer

A
  1. Smoking
  2. Chronic pancreatitis
  3. Family history
  4. Late onset diabetes mellitus
  5. Lynch Syndrome
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2
Q

What is a key presenting feature that should make you immediately consider pancreatic cancer?

List a ddx for this feature

A

Painless obstructive jaundice

Key differential is cholangiocarcinoma

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3
Q

What causes Painless obstructive jaundice?

A

When a tumour at the head of the pancreas compresses the bile ducts, blocking the flow of bile out of the liver

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4
Q

How does Painless obstructive jaundice present?

A
  1. Yellow skin and sclera
  2. Pale stools
  3. Dark urine
  4. Generalised itching
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5
Q

List 4 other symptoms for pancreatic cancer

(Hint: they are vague)

A
  1. Non-specific upper abdominal or back pain
  2. Unintentional weight loss
  3. Palpable mass in the epigastric region
  4. Change in bowel habit
  5. Nausea or vomiting
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6
Q

List 4 other signs of pancreatic cancer

(Hint: they are vague)

A
  1. Palpable mass in the epigastric region
  2. Cachectic patient
  3. Jaundice
  4. Palpable mass
  5. Hepatomegaly
  6. Ascites
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7
Q

What sign specifically related to diabetes, may indicate pancreatic cancer?

A

New onset of diabetes, or worsening glycaemic control despite good lifestyle measures and medication

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8
Q

What are the NICE criteria on when to refer for suspected pancreatic cancer?

A
  1. > 40 + jaundice – 2 week wait referral
  2. > 60 + weight loss + an additional symptom – referred for a direct access CT abdomen

Additonal symptoms: Diarrhoea, back pain, abdo pain, nausea, vomiting, constipation, new‑onset diabetes

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9
Q

What is the only scenario where GPs can refer directly for a CT scan?

A

Suspected pancreatic cancer

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10
Q

What is Courvoisier’s law?

A

States that a palpable gallbladder along with jaundice is unlikely to be gallstones

The cause is usually cholangiocarcinoma or pancreatic cancer

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11
Q

What is Trousseau’s sign?

A

Migratory thrombophlebitis as a sign of malignancy, esp adenocarcinoma.

  • Thrombophlebitis → inflammation of BVs with an associated thrombus in that area
  • Migratory → thrombophlebitis reoccurring in different locations over time
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12
Q

95% of pancreatic cancers are _________ and arise from _________ cells. These have a _________ prognosis

Less than 5 % of pancreatic tumours arise from _________ cells and are known as called a _________ tumours.

A

adenocarcinomas, exocrine, worse, endocrine, neuroendocrine

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13
Q

Compare a functional vs Non Functioning neuroendocrine tumour (NET)

A

Functional → release hormones ie. Gastrinoma, Insulinoma

Non Functioning → Carcinoid releases serotonin (5-HT) or its precursor (5-HTP) often arise elsewhere in body and metastasise to pancreas

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14
Q

Insulinomas arise from what cell type?

What is the Whipple Triad?

A

Beta cell

Whipple Triad:

  1. Symptoms of hypoglycaemia
  2. Low plasma glucose
  3. Rapid relief of symptoms with glucose administration
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15
Q

What cell type do Glucagonomas arise from?

What is meant by its 4D Syndrome?

A

alpha Cells

4D Syndrome: Dermatitis, Diabetes, DVT, Depression

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16
Q

What do VIPomas secrete?

What syndrome does it present with?

A

VIP (vasoactive intestinal peptide)

WHDA Syndrome: Watery Diarrhoea, Hypokalaemia Achlorhydria

17
Q

How does Zollinger Ellison Syndrome (gastroma) present?

What would be seen on endoscopy?

A

Presents: abdo pain, diarrhoea, heartburn

Endoscopy: severe peptic ulceration

18
Q

From which cells do Somatostatinoma arise?

With which syndrome do these present?

A

Delta cells

Inhibitory Syndrome: Diabetes, Steatorrhoea, Cholilithiasis

19
Q

List 2 other pancreatic tumours

A
  1. Serous Cystadenomas - benign
  2. Mucinous cystic neoplasms of the pancreas
  3. Intraductal Papillary Mucinous Neoplasms (IPMN)
20
Q

What is the initial imaging for suspected pancreatic cancer?

What may/may not be seen

A

Abdominal USS → may demonstrate a pancreatic mass or a dilated biliary tree

  1. Not good in early disease but hepatic metastases and ascites may be seen in late stage disease
  2. Tail /body of pancreas often obscured by gas and hence not seen
21
Q

What may blood tests show in pancreatic cancer?

A

FBC - anaemia or thrombocytopenia

LFTs - ↑ bilirubin, ALP, and GGT

22
Q

What is the gold standard investigation for diagnosis of pancreatic cancer?

What sign may be seen?

A

High-resolution CT scan

May demonstrate the ‘double duct’ sign - presence of simultaneous dilatation of the CBD and PDs

23
Q

What tumour marker may be raised in pancreatic cancer?

When is this marker used clinically

A

CA 19-9

Used clinically for assessing response to treatment rather than for initial diagnosis as it is raised in a number of conditions (ie. cholangiocarcinoma)

24
Q

What is the role of MRCP and ERCP in suspected pancreatic cancer?

A

MRCP - to assess biliary system in detail to assess the obstruction

ERCP - to put a stent in and relieve the obstruction, and also obtain a biopsy from the tumour

25
Q

What investigation may assist in staging pancreatic cancer?

A

CT thorax, abdomen and pelvis (CT TAP) for staging and to look for metastasis and other cancers

26
Q

What surgical options are available for pancreatic cancer?

A
  1. Total pancreatectomy
  2. Distal pancreatectomy
  3. Pylorus-preserving pancreaticoduodenectomy (PPPD) (modified Whipple procedure)
  4. Radical pancreaticoduodenectomy (Whipple procedure)

Only considered with small tumours isolated in the head of the pancreas (10% of cases)

27
Q

List 4 palliative treatments for pancreatic cancer

A
  1. Stents to relieve biliary obstruction
  2. Surgery to improve symptoms (e.g. bypassing the biliary obstruction)
  3. Palliative chemo or radiotherapy (to improve symptoms and extend life)
  4. End of life care with symptom control
28
Q

Briefy explain a Whipple Procedure (pancreaticoduodenectomy)

A

A surgical procedure to remove a tumour of the head of the pancreas that has not spread. It involves removal of the:

  • Head of the pancreas
  • Pylorus of the stomach
  • Duodenum
  • Gallbladder
  • Bile duct
  • Relevant lymph nodes