Pancreatic cancer

Question 1

Presentation?

Answer 1

Upper abdo pain
Weight loss
Anorexia
Jaundice - if biliary obstruction or liver mets

Others:
Steatorrhea
Polyuria, polydipsia, nausea, nocturia (new onset DM)

Advanced disease:
+ve Courvoiseirs
+ve Troussea’s - migratory superficial thrombophlebitis
petechiae, bruising - DIC

RFs; HNPCC, Peutz-Jeghers

Question 2

ivx?

Answer 2

Abdo US - mass, dalted bile ducts
Abdo CT - “

LFTs - obstructive jaundice picture - may be due to cancer compressing bile ducts or liver mets

CA19-9

If CEA +ve could be metastatic colon cancer

Question 3

rx?

Answer 3

stage 1/2:
- Resection + chemo

Stage 3/4 advanced:

• Palliative surgery OR stent insertion
• Chemo
• Pain relief
• Replace pancreatic enzymes (and vit ADEK)

Question 4

prognosis

Answer 4

5 year survival 20% - stage 1/2

stage 4 - 50% 6 month survival