Pancreatic Cancer

Question 1

What is the most common type of pancreatic cancer and which part of the pancreas is most commonly effected?

Answer 1

Ductal adenocarcinoma

Head of pancreas= 60%
Body=25% and tail= 15%

Question 2

Why does pancreatic cancer have such a poor prognosis?

What are the common sites of metastasis?

Answer 2

Presents late and metastasises early meaning likely have quite advanced disease by the time it presents

Liver
Peritoneum
Lungs
Bones

Question 3

What is the typical presentation of head of pancreas cancer?

Answer 3

> 60
HX of smoking/alcohol/DM/chronic pancreatitis
Painless obstructive jaundice due to tumour in head of pancreas compressing bile ducts (Dark urine + pale stools)

Weight loss

Diabetes= new-onset or worsening

Acute pancreatitis

RUQ/epigastric mass

Hepatomegaly

Ascites

Change in bowel habits

Question 4

What is the typical presentation of cancer of body or tail of pancreas?

Answer 4

Epigastric pain radiating to back 
Relieved when sitting forward 
Weight loss 
Diabetes 
Acute pancreatitis 

Similar presentation to pancreatitis

Question 5

What investigations would you do if you suspected pancreatic cancer?

Answer 5

LFTs + gammaGT= looking for obstructive picture
CA19-9= tumour marker
-not specific for pancreatic cancer but can be used as marker of prognosis in tertiary setting

USS

• dilatation of biliary tree
• locations of obstruction
• liver mets

CT TAP
-used for staging

MRCP= assess detail of biliary tree
ECRP= can be to put in stent and get biopsy

Question 6

How is pancreatic cancer managed?

Answer 6

Needs discussing at HPB MDT

Pancreatoduodenectomy (whipple procedure)= for small tumours isolated to the head of the pancreas
NOTE: a lot of patients present too late and are not fit for surgery

Palliative treatment:

• ECRP to insert stents to relieve obstruction and associated symptoms
• bypass biliary obstruction via surgery
• palliative chemo- reduce symptoms and extend life
• palliative radiotherapy
• EOL symptom care= pain/jaundice/pruritis

Question 7

What does a pancreaticoduodenectomy (whipple procedure) involve?

Answer 7

Removal of tumour of head of pancreas which has not spread
MAJOR OPERATION

Removal of:

• head of pancreas
• pylorus of stomach
• duodenum
• gall bladder
• bile duct
• relevant lymph nodes