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#Phase 2.2: Acute Care > Pancreatic Cancer > Flashcards

Pancreatic Cancer Flashcards

(36 cards)

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1
Q

What are the risk factors for Pancreatic cancer? (7 things)

A
  1. Smoking
  2. Alcohol
  3. Carcinogens
  4. DM
  5. Chronic Pancreatitis
  6. High waist circumference
  7. High fat + Red / Processed meat diet
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2
Q

What type of cancer is Pancreatic cancer usually?

A

Ductal adenocarcinoma

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3
Q

What is a characteristic of Ductal adenocarcinomas? (2 things)

A
  1. Metastasize early

2. Present late

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4
Q

Which part of the pancreas do most pancreatic cancers arise in? (4 things)

A
  1. 60% = pancreas head
  2. 25% = pancreas body
  3. 15% = pancreas tail
  4. A few in ampulla of Vater / pancreatic islet cells
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5
Q

Which pancreatic cancer arises in the ampulla of Vater?

A

Ampullary tumour

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6
Q

Which pancreatic cancers arise in the pancreatic islet cells? (5 things)

A
  1. Insulinoma
  2. Gastrinoma
  3. Glucagonoma
  4. Somatostanimo
  5. VIPomas
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7
Q

Which pancreatic cancers have better prognosis than the rest? (2 things)

A
  1. Ampulla of Vater cancers

2. Pancreatic islet cell cancers

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8
Q

What is the genetic significance of pancreatic cancer?

A

95% have mutations in KRAS2 gene

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9
Q

Where do Pancreatic cancers spread to? (4 things)

A
  1. Liver (FIRST)
  2. Peritoneum
  3. Lungs
  4. Bones
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10
Q

What is the key CF that should make you instantly think of Pancreatic HEAD Cancer as a differential?

A

Painless Obstructive Jaundice

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11
Q

How does Pancreatic HEAD cancer cause Obstructive jaundice?

A

Tumour of pancreas HEAD grows and compresses bile ducts

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12
Q

What is the other DD of Painless Obstructive Jaundice?

A

Cholangiocarcinoma

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13
Q

What are the CF of Painless Obstructive Jaundice in Pancreatic HEAD Cancer? (4 things)

A
  1. Yellow skin + sclera
  2. Pale stools
  3. Dark urine
  4. Generalised itching
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14
Q

What do 75% of Pancreatic BODY / TAIL Cancers present with? (3 things)

A
  1. Epigastric pain
  2. Radiates to back
  3. Relieved by sitting forward
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15
Q

What are the other CF of Pancreatic Cancers? (10 things)

A
  1. Palpable gall bladder (Courvoisiers’s Sign)
  2. Ascites
  3. N + V + D
  4. Change in bowel habits
  5. Rastafarian lymphadenopathy
  6. Epigastric mass
  7. jAndince
  8. Splenomegaly + Hepatomegaly
  9. Weight loss (late)
  10. New onset DM / Worsening T2DM (late)
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16
Q

What is Courvoisier’s Sign in Pancreatic Cancer?

Study These Flashcards
A

Enlarged, palpable, non-tender gallbladder

17
Q

What does Courvoisier’s Law state? (2 things)

Study These Flashcards
A
  1. Palpable gallbladder with jaundice is UNLIKELY to be gallstones
  2. The cause is usually Pancreatic Cancer OR Cholangiocarcinoma
18
Q

How does Pancreatic Cancer cause Splenomegaly?

Study These Flashcards
A

Cancer in BODY / TAIL –> splenic vein obst

19
Q

Which patients does NICE say you should refer for sus Pancreatic Cancer?

Study These Flashcards
A
  1. 40+ yrs old w Jaundice = refer on 2 wk wait

2. 60+ yrs old w Weight Loss + 1 more of 7 NICE symptoms = refer for DIRECT ACCESS CT ABDO

20
Q

What are the 7 NICE symptoms that when present w Weight Loss in a 60+ yr old, must be referred for Direct Access CT Abdo? (7 things)

Study These Flashcards
A
  1. N / V / D
  2. Constipation
  3. Abd / Back pain
  4. New onset diabates
21
Q

What investigations should be done for sus Pancreatic Cancer?

Study These Flashcards
A
  1. Imaging (usually CT)
  2. Biopsy
  3. CA19-9 tumour marker
  4. MRCP
  5. ERCP
22
Q

What is the diagnosis of Pancreatic cancer based on? (2 things)

Study These Flashcards
A
  1. Imaging (usually CT)

2. Biopsy

23
Q

What CT is done sus Pancreatic Cancer?

Study These Flashcards
A

Staging CT TAP (thorax, abd, pelvis)

24
Q

What is the CT for sus Pancreatic Cancer used to look at? (2 things)

Study These Flashcards
A
  1. Metastasis

2. Other cancers

25
What tumour marker is used to assess PROGNOSIS of Pancreatic Cancer?
CA19-9
26
Why is CA19-9 not used for DIAGNOSIS of Pancreatic Cancer? (2 things)
1. It’s non specific | 2. Also raised in Cholangiocarcinoma + other conditions
27
What is MRCP used for in sus Pancreatic Cancer?
Assess biliary system to assess obstruction
28
What is ERCP used for in sus Pancreatic Cancer? (3 things)
1. Insert stent 2. Relieve obstruction 3. Obtain biopsy
29
Where will the management of a Pancreatic cancer patient be decided?
Hepatobiliary (HPB) MDT meeting
30
What percentage of Pancreatic Cancers are suitable for radical surgery?
Under 20% :(
31
What are the Surgical options for Pancreatic Cancers? (4 things)
1. Total pancreatectomy 2. Distal pancreatectomy (body n tail) (done laparoscopically) 3. Radical PancreaticoDuodenectomy (Whipple Procedure) 4. Pylorus-Preserving PancreaticoDuodenectomy (PPPD) (modified Whipple Procedure)
32
What is Whipple Procedure?
Surgery to remove Pancreas Head Tumour that HASN’T spread
33
What does Whipple Procedure remove? (6 things)
1. Pancreas head 2. Duodenum 3. Gallbladder 4. Bile duct 5. Relevant lymph nodes 6. (Sometimes parts of Stomach + Pancreas Body)
34
What is Pylorus-Preserving PancreaticoDuodenectomy (PPPD) (modified Whipple Procedure)?
Same as Whipple Procedure but you just leave the Pylorus of stomach in place
35
What are the Palliative options for Pancreatic Cancers? (4 things)
1. Stent insertion to relieve biliary obst 2. Surgery to bypass biliary obst 3. Palliative chemo / radio 4. Opiates for pain (End of life)
36
What is the mean survival time for Pancreatic Cancer?
Under 6 months :(

#Phase 2.2: Acute Care (31 decks)

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