Pancreatic Cancer Flashcards
What is pancreatic cancer?
It is defined as the proliferation of malignant cells in the pancreas
In most cases, what is the histology classification of pancreatic cancer?
Adenocarcinoma
In most cases, what region of the pancreas tends to be affected by pancreatic cancer?
Head of the pancreas
What are the eight risk factors of pancreatic cancer?
Older Age
Family History
Chronic Pancreatitis
Hereditary Non-Polyposis Colorectal Carcinoma
Multiple Endocrine Neoplasia
Diabetes Mellitus
Obesity
Smoking
What two genes are associated with pancreatic cancer?
KRAS-2
BRCA 2
What is the main gene associated with pancreatic cancer?
KRAS-2
What are the ten clinical features associated with pancreatic cancer?
Painless Jaundice
Palpable Gallbladder
Trousseau Sign
Pale Stools
Dark Urine
Steatorrhoea
Pruritus
Weight Loss
Hepatomegaly
Lymphadenopathy
What is the main clinical feature of pancreatic cancer?
Painless jaundice
Describe the epigastric pain associated with pancreatic cancer
It radiates to the back
It is relieved by sitting forward
What does Courvoisier’s Law state? How does this relate to pancreatic cancer?
It states that in the presence of painless jaundice, a palpable gallbladder is unlikely to be due to gallstones
This means that when both painless jaundice and a palpable gallbladder present - a diagnosis of pancreatic cancer is indicated
What is Trousseau’s sign?
It is defined as migratory thrombophlebitis
What is migratory thrombophlebitis?
It is is an inflammatory reaction of the vein accompanied by a thrombus
What is the pathophysiological cause of steatorrhoea?
Decreased lipase levels
What lymphadenopathy is associated with pancreatic cancer?
Virchow’s node
What is Virchow’s node?
It is the lymph node present in the left supraclavicular region
What are the four investigations used to diagnose pancreatic cancer?
Blood Tests
Ultrasound Scan
CT Scan
Endoscopic Retrograde Cholangiopancreatography (ERCP)
What are the six blood test results indicative of pancreatic cancer?
Increased CA19-9 Levels
Increased CEA Levels
Increased ALP Levels
Increased Bilirubin Levels
Increased GGT Levels
Increased Glucose Levels
What two tumour markers are associated with pancreatic cancer?
CA19-9
CEA
What is the main tumour marker associated with pancreatic cancer?
CA19-9
CA19-9 is non-specific. What other four conditions are associated with increased CA19-9 levels?
Gastrointestinal malignancies
Liver cirrhosis
Pancreatitis
Inflammatory bowel disease
How are ultrasound scans used to manage pancreatic cancer?
They are used to assess for pancreatic cancer tumours, as well as any associated complications
Why can ultrasound scans produce false negative results of pancreatic cancer?
The pancreas is positioned behind gas-filled bowel loops and intraperitoneal fat
What is the gold standard investigation used to diagnose pancreatic cancer?
CT scan
What sign on CT scans is associated with pancreatic cancer? What does this suggest?
Double duct sign
This suggests simultaneous dilation of the common bile and pancreatic ducts
CT scans can be used to obtain guided biopsies of pancreatic cancer. Why do we avoid this in resectable tumours?
This is due to the risk of seeding cancer cells within the peritoneal cavity
What is ERCP?
It involves the insertion of an endoscope through the oesophagus, stomach and into the duodenum
In the duodenum, the endoscope is then guided through the sphincter of Oddi into the bile duct – where contrast is injected, and x-rays are then taken
How is ERCP used to investigate pancreatic cancer?
Brushings for cytology
OR
Biopsies for histopathological diagnosis
What are the four surgical management options used in pancreatic cancer?
Pancreatoduodenectomy
Distal Pancreatotomy
Total Pancreatotomy
Endoscopic Retrograde Cholangiopancreatography (ERCP)
What is another term for pancreatoduodenectomy?
Whipple’s resection
What is pancreatoduodenectomy?
It involves surgical removal of the head of the pancreas, duodenum, common bile duct and gallbladder – with or without extended dissection of additional lymph nodes
What two incisions are used in pancreatodudodenectomy?
Rooftop
Midline
What are the two complications following pancreatoduodenectomy?
Dumping syndrome
Peptic ulcer disease
How do we restore gastrointestinal function following pancreatoduodenectomy?
We create a Roux en-Y loop from a segment of jejunum to enable anastomosis
What three anastomosis are formed with a Roux en-Y loop?
Pancreatojejunostomy
Hepaticojejunostomy
Duodenojejunostomy
What is a pancreatojejunostomy?
It enables drainage of pancreatic secretions into the small bowel
What is a hepaticojejunostomy?
It enables drainage of bile secretions into the small bowel
What is a duodenojejunostomy?
It enables restoration of the gastrointestinal tract continuity
What is a distal pancreatotomy?
It involves resection of the body/tail of the pancreas, as well as the spleen
When is distal pancreatotomy recommended?
It is recommended in cases where malignancy is confined to the body/tail of the pancreas
What is total pancreatotomy?
It involves resection of the whole pancreas, as well as the duodenum, common bile duct, gallbladder and spleen
When is total pancreatotomy recommended?
It is recommended in cases where malignancy is diffuse or confined to pancreas, involving the neck region
How is ERCP used to manage pancreatic cancer?
It can be used to insert a sent into the bile duct to relieve compression caused by pancreatic cancer
This enables drainage of bile
When is ERCP recommended as a management option?
It is used as a palliative management option to provide symptomatic relief
How is chemotherapy used to manage pancreatic cancer?
It can be administered adjuvantly, in combination with management techniques to improve the likelihood of success
