Pancreatic Cancer Flashcards
At what age group does most pancreatic cancers occur?
60-80 yrs
What is the most common type of pancreatic cancer?
Ductal carcinoma - arises from exocrine portion of gland - 90%
What are the remaing less common pancreatic cancers?
Exocrine tumours - pancreatic cystic carcinoma
Endocrine tumours - from islet cells
Where in the pancreas are pancreatic cancers most common?
Head of pancreas - 60-70%
Where else can cancers occur in the pancreas?
Body and tail
Diffuley invlove the pancreas
Why are pancreatic cancers in the body and tail more likely to be diagnosed at an advanced stage?
Less likely to have Obstructive symptoms
What are the risk factors for pancreatic cancers?
Smoking
Chronic pancreatitis
Dietary factors (high red meat intake, low fruit and vegtable intake)
FH
Late onset DM - 8x more risk if diagnosed >50 yrs of age
What is a red flag for pancreatic cancers?
Painless jaundice
What are some of the presenting features of pancreatic cancers?
80% unresctable at diagnosis as vague symptoms:
Obstructive jaundice
Weight loss
Abdominal pain
Examination - cachetic, malnourished and jaundiced. Abdominal mass in epigastric region as well as an enlarged gallbldder. (Courvoisiers law)
What some less common presentations of pancreatic cancers?
Acute pancreatitis
Thrombophlebitis migrans
What are the differential diagnosis of pancreatic cancers?
Causes of obstructive jaundice - gallstone disease, cholangiocarcinoma
Epigastric abdominal pain - PUD, gastri cancer, ACS
What is the tumour marker specfic for pancreatic cancers and what is its role?
CA19-9
Assessing response to treatment rather then intial diagnosis
Other then bloods what investigations sould be ordered for pancreatic cancers?
Abdominal ultrasound - pancreatic mass or dilated bilary tree
CT imaging (pnacreatic protacol) - GOLD standard to diagnose
Staging CT
PET scan or MRCP may be useful in unclear diagnosis
EUS - endoscopic ultrasound for staging, biposy and histology
What is the curative management option for pancreatic adenocarcinoma?
Radical resection
How can pancreatic cancers be classifed?
Resectable
Borderline resctable
Unresectable:
Locally advanced - depending on contact with surrounding vessels
Metastatic
What is the surgery of choice for pancreatic cancers located in the head of the pancreas?
Pancreaticoduodenectomy (Whipples procedure) with regional lymphadenectomy
What is the surgery of choice for pancreatic cancers loctaed in the body or tail of pancreas?
Distal pancreatectomy +/- splenectomy with reginol lymphadenopathy
What are specific complications of pancreatic cancer surgery?
Pancreatic fistula
Delayed gastric emptying
Pancreatic insufficiency
What should all surgical patients recieve after pancreatic cancer surgery?
Adjuvant chemotherapy
What is removed in whipples procedure and why?
Head of the pnacreas Antrum of stomach 1st and 2nd parts of duodenum Common bile duct Gallbladder
All due to their common blood supply - gastroduodenal artery
What happens after removal in whipples procedure?
Tail of pancreas and heaptic duct joined to jejunum. Stomach anastomosis with the jejunum
What is the management for non resectable tumours?
Chemotherapy - Gemcitabine
Metastatic disease - good performance status - FOLFIRINOX, or gemcitabine if cant tolerate
Symptomatic management if poor performance status - obstruction relived by inserting biliary stent. Exocrine insufficiency- enzyme replacemnts(Creon)
What are the two classiications of endocrine pancreatic cancers?
Functional - secrete hormones - signs and symptoms related to this
Non-functional - dont secrete hormones and clinical features purely malginant spread
Often associated with Multiple endocrine neoplasia 1 syndrome (MEN1)
What does MEN1 typically consist of?
Hyperparathyrosim
Endocrine pancreatic tumours
Pituitary tumours
What is the management of endocrine pancreatic cancers?
Blood tests to identify specfic subtype
CT imaging, MRI imaging and EUS
Observe and resect
Somatostain analogues could be used
Which hormone is in excess in Zollinger-Ellison syndrome?
Gastrin
