pancreatic cancer

Question 1

what is the double duct sign?

Answer 1

seen on CT:
- not seen in all cases of pancreatic cancer but if it is present is either pancreatic or ampulla vater cancer. It is a dilated common bile duct and dilated pancreatic duct.

Question 2

What type of cancer are most pancreatic cancers?

Answer 2

Over 80% of pancreatic tumours are adenocarcinomas which typically occur at the head of the pancreas

Question 3

what are associations with pancreatic cancer?

Answer 3

increasing age
smoking
diabetes
chronic pancreatitis (alcohol does not appear an independent risk factor though)
hereditary non-polyposis colorectal carcinoma
multiple endocrine neoplasia
BRCA2 gene
KRAS gene mutation

Question 4

what is couriers law?

Answer 4

• painless jaundice and palpable gallbladder is unlikely to be gallstones and more likely pancreatic cancer

Question 5

what trousseaus syndrome?

Answer 5

Thrombophlebitis Migrans (Trousseau Syndrome) is a classic example of paraneoplastic syndrome, caused by adenocarcinomas predominantly of the stomach, pancreas, and lung.

presents as recurring and migrating episodes of thrombophlebitis that can involve the upper and lower limbs, thoracic and abdominal wall, and the major blood vessels of the abdomen. These recurring episodes may lead to a detachment of a thrombus and the formation of pulmonary thromboembolism (PTE), often proving fatal for the patien

Question 6

what will the liver function tests look like in pancreatic cancer?

Answer 6

cholestatic picture

Question 7

what are the imaging investigations of choice?

Answer 7

ultrasound has a sensitivity of around 60-90%

high-resolution CT scanning is the investigation of choice if the diagnosis is suspected

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

Question 8

what is the management of pancreatic cancer?

Answer 8

less than 20% are suitable for surgery at diagnosis

a Whipple’s resection (pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas.

adjuvant chemotherapy is usually given following surgery

ERCP with stenting is often used for palliation

Question 9

what are side effects of the whipples procedure?

Answer 9

Side-effects of a Whipple’s include dumping syndrome and peptic ulcer disease