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Gen surg > Pancreatic cancer > Flashcards

Pancreatic cancer Flashcards

1
Q

What type of cancers are most pancreatic cancers

A

Adenocarcinomas

Most occur in the head of the pancreas

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2
Q

Features of pancreatic cancers

A

Pancreatic cancers tend to spread and metastasise early, particularly to the liver, then to the peritoneum, lungs and bones. The average survival, when diagnosed with advanced disease, is around 6 months.

When caught early, the cancer is isolated to the pancreas and surgery is possible, the 5-year survival is still around 25% or less.

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3
Q

Presentation of pancreatic cancer

A 
Painless obstructive jaundice 
Yellow skin and sclera 
Pale stools 
Dark urine 
Generalised itching 
New-onset diabetes or worsening of type 2 diabetes
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4
Q

When should patients with suspected pancreatic cancer be referred

A

Over 40 with jaundice – referred on a 2 week wait referral

Over 60 with weight loss plus an additional symptom (see below) – referred for a direct access CT abdomen

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5
Q

When should patients have a gp referral for a direct access CT abdomen in suspected pancreatic cancer

A

Weight loss plus any of:

Diarrhoea
Back pain
Abdominal pain
Nausea
Vomiting
Constipation
New‑onset diabetes
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6
Q

What is courvoisier’s law

A

Courvoisier’s law 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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7
Q

What is trousseau’s sign of malignancy

A

Refers to migratory thrombophlebitis as a sign of malignancy, particularly pancreatic adenocarcinoma.

Thrombophlebitis is where blood vessels become inflamed with an associated blood clot (thrombus) in that area. Migratory refers to the thrombophlebitis reoccurring in different locations over time.

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8
Q

IX for pancreatic cancer

A

Staging CT scan(CT thorax, abdomen and pelvis)
MRCP
ERCP
Biopsy

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9
Q

Which tumour marker is raised in pancreatic cancer

A

CA 19-9

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10
Q

Surgical options for pancreatic cancer

A

Total pancreatectomy
Distal pancreatectomy
Pylorus-preserving pancreaticoduodenectomy (PPPD) (modified Whipple procedure)
Radical pancreaticoduodenectomy (Whipple procedure)

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11
Q

What might palliative treatment for pancreatic cancer involve

A 
Stents inserted to relieve the biliary obstruction
Surgery to improve symptoms (e.g., bypassing the biliary obstruction)
Palliative chemotherapy (to improve symptoms and extend life)
Palliative radiotherapy (to improve symptoms and extend life)
End of life care with symptom control
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12
Q

What is the Whipple procedure

A

Removal of:

Head of the pancreas
Pylorus of the stomach
Duodenum
Gallbladder
Bile duct
Relevant lymph nodes
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13
Q

Pancreatic cancer associations

A

increasing age
smoking
diabetes
chronic pancreatitis (alcohol does not appear an independent risk factor though)
hereditary non-polyposis colorectal carcinoma
multiple endocrine neoplasia

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14
Q

Genes associated with pancreatic cancer

A

BRCA2

KRAS mutation

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15
Q

LFT derangement in pancreatic cancer

A

Cholestatic liver function tests

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16
Q

What sign might imaging show which indicates pancreatic cancer

A

imaging may demonstrate the ‘double duct’ sign - the presence of simultaneous dilatation of the common bile and pancreatic ducts

17
Q

Most likely causes of acute pancreatitis

A

alcohol or gallstones

18
Q

Features of acute pancreatitis

A

Severe epigastric pain radiating to back

Vomiting

19
Q

Examination features of acute pancreatitis

A

epigastric tenderness, ileus and low-grade fever

periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare

20
Q

IX in acute pancreatitis

A 
FBC
U&E
LFT
Calcium 
ABG

Amylase, CRP

21
Q

Imaging ix in acute pancreatitis

A

Ultrasound for gallstones

CT abdomen for complications such as necrosis and abscesses

22
Q

Scoring system for pancreatitis

A 
P – Pa02 < 8 KPa
A – Age > 55
N – Neutrophils (WBC > 15)
C – Calcium < 2
R – uRea >16
E – Enzymes (LDH > 600 or AST/ALT >200)
A – Albumin < 32
S – Sugar (Glucose >10)

Glasgow score

23
Q

Mx of acute pancreatitis

A 
A-E
IV fluids 
NBM 
Analgesia 
Treatment of complications(endoscopic or percutaneous drainage of large collections)
24
Q

Treatment of gallstones

A

ERCP

Cholecystectomy

25
Q

Complications of acute pancreatitis

A 
Necrosis 
Infection 
Abscess 
Pseudocysts 
Chronic pancreatitis
26
Q

Most common cause of chronic pancreatitis

A

Alcohol

27
Q

Key complications of chronic pancreatitis

A

Chronic epigastric pain

Loss of exocrine function(lipase)

Loss of endocrine(lack of insulin leading to diabetes)

Pseudocysts/abscesses

28
Q

Mx of chronic pancreatitis

A

Abstinence from alcohol and smoking

Analgesia

Replacement pancreatic enzymes(croon)

Subcut insulin for diabetes

ERCP with stenting

Gen surg (24 decks)

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