Pancreatic cancer

Question 1

What type of cancer is the majority of pancreatic cancers?

Answer 1

Pancreatic adenocarcinoma

Question 2

1) How do pancreatic tumours usually present
2) Name 2 other ways they can present
3) Name 2 non-specific ways pancreatic cancers can present

Answer 2

1) Painless obstructive jaundice (Courvoisier’s sign)
2) Pale stools, dark urine, generalised itching, thrombophlebitis migrans
3) Non-specific upper abdominal or back pain, weight loss, palpable mass in the epigastric region, change in bowel habit, nausea or vomiting, new-onset diabetes or worsening of type 2 diabetes

Question 3

If GPs suspect pancreatic cancer (weight loss + 1 other pancreatic cancer symptom), what investigation can they refer a patient to?

Answer 3

CT abdomen (ultrasound if CT unavailable)

Question 4

Name 2 risk factors for the development of pancreatic cancer

Answer 4

• Smoking
• Alcohol
• Obesity
• Chronic pancreatitis
• Carcinogens

Question 5

1) What tumour maker may be raised in pancreatic cancer?
2) Name 2 other investigations that may be used in pancreatic cancer

Answer 5

1) CA 19-9
2) Staging CT scan, magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography

Question 6

1) What is the only curative option for pancreatic cancer?
2) What is a Whipple’s procedure?
3) Name 3 things that get removed in a Whipple’s procedure

Answer 6

1) Surgery
2) Surgical operation to remove a tumour of the head of the pancreas that has not spread
3) Head of the pancreas, pylorus of the stomach, duodenum, gallbladder, bile duct, relevant lymph nodes

Question 7

When surgery is not possible - palliative treatment is the only option. Name 2 aspects of the palliative treatment of pancreatic cancer

Answer 7

• Stents inserted to relieve the biliary obstruction
• Surgery to improve symptoms
• Palliative chemotherapy
• Palliative radiotherapy
• End of life care with symptom control