Pancreatic Cancer

Question 1

What is pancreatic cancer?

Answer 1

It is defined as the proliferation of malignant cells in the pancreas

Question 2

In most cases, what is the histology classification of pancreatic cancer?

Answer 2

Adenocarcinoma

Question 3

In most cases, what region of the pancreas tends to be affected by pancreatic cancer?

Answer 3

Head of the pancreas

Question 4

What are the eight risk factors of pancreatic cancer?

Answer 4

Older Age

Family History

Chronic Pancreatitis

Hereditary Non-Polyposis Colorectal Carcinoma

Multiple Endocrine Neoplasia

Diabetes Mellitus

Obesity

Smoking

Question 5

What two genes are associated with pancreatic cancer?

Answer 5

KRAS-2

BRCA 2

Question 6

What is the main gene associated with pancreatic cancer?

Answer 6

KRAS-2

Question 7

What are the ten clinical features associated with pancreatic cancer?

Answer 7

Painless Jaundice

Palpable Gallbladder

Trousseau Sign

Pale Stools

Dark Urine

Steatorrhoea

Pruritus

Weight Loss

Hepatomegaly

Lymphadenopathy

Question 8

What is the main clinical feature of pancreatic cancer?

Answer 8

Painless jaundice

Question 9

Describe the epigastric pain associated with pancreatic cancer

Answer 9

It radiates to the back

It is relieved by sitting forward

Question 10

What does Courvoisier’s Law state? How does this relate to pancreatic cancer?

Answer 10

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

Question 11

What is Trousseau’s sign?

Answer 11

It is defined as migratory thrombophlebitis

Question 12

What is migratory thrombophlebitis?

Answer 12

It is is an inflammatory reaction of the vein accompanied by a thrombus

Question 13

What is the pathophysiological cause of steatorrhoea?

Answer 13

Decreased lipase levels

Question 14

What lymphadenopathy is associated with pancreatic cancer?

Answer 14

Virchow’s node

Question 15

What is Virchow’s node?

Answer 15

It is the lymph node present in the left supraclavicular region

Question 16

What are the four investigations used to diagnose pancreatic cancer?

Answer 16

Blood Tests

Ultrasound Scan

CT Scan

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Question 17

What are the six blood test results indicative of pancreatic cancer?

Answer 17

Increased CA19-9 Levels

Increased CEA Levels

Increased ALP Levels

Increased Bilirubin Levels

Increased GGT Levels

Increased Glucose Levels

Question 18

What two tumour markers are associated with pancreatic cancer?

Answer 18

CA19-9

CEA

Question 19

What is the main tumour marker associated with pancreatic cancer?

Answer 19

CA19-9

Question 20

CA19-9 is non-specific. What other four conditions are associated with increased CA19-9 levels?

Answer 20

Gastrointestinal malignancies

Liver cirrhosis

Pancreatitis

Inflammatory bowel disease

Question 21

How are ultrasound scans used to manage pancreatic cancer?

Answer 21

They are used to assess for pancreatic cancer tumours, as well as any associated complications

Question 22

Why can ultrasound scans produce false negative results of pancreatic cancer?

Answer 22

The pancreas is positioned behind gas-filled bowel loops and intraperitoneal fat

Question 23

What is the gold standard investigation used to diagnose pancreatic cancer?

Answer 23

CT scan

Question 24

What sign on CT scans is associated with pancreatic cancer? What does this suggest?

Answer 24

Double duct sign

This suggests simultaneous dilation of the common bile and pancreatic ducts

Question 25

CT scans can be used to obtain guided biopsies of pancreatic cancer. Why do we avoid this in resectable tumours?

Answer 25

This is due to the risk of seeding cancer cells within the peritoneal cavity

Question 26

What is ERCP?

Answer 26

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

Question 27

How is ERCP used to investigate pancreatic cancer?

Answer 27

Brushings for cytology OR Biopsies for histopathological diagnosis

Question 28

What are the four surgical management options used in pancreatic cancer?

Answer 28

Pancreatoduodenectomy Distal Pancreatotomy Total Pancreatotomy Endoscopic Retrograde Cholangiopancreatography (ERCP)

Question 29

What is another term for pancreatoduodenectomy?

Answer 29

Whipple’s resection

Question 30

What is pancreatoduodenectomy?

Answer 30

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

Question 31

What two incisions are used in pancreatodudodenectomy?

Answer 31

Rooftop Midline

Question 32

What are the two complications following pancreatoduodenectomy?

Answer 32

Dumping syndrome Peptic ulcer disease

Question 33

How do we restore gastrointestinal function following pancreatoduodenectomy?

Answer 33

We create a Roux en-Y loop from a segment of jejunum to enable anastomosis

Question 34

What three anastomosis are formed with a Roux en-Y loop?

Answer 34

Pancreatojejunostomy Hepaticojejunostomy Duodenojejunostomy

Question 35

What is a pancreatojejunostomy?

Answer 35

It enables drainage of pancreatic secretions into the small bowel

Question 36

What is a hepaticojejunostomy?

Answer 36

It enables drainage of bile secretions into the small bowel

Question 37

What is a duodenojejunostomy?

Answer 37

It enables restoration of the gastrointestinal tract continuity

Question 38

What is a distal pancreatotomy?

Answer 38

It involves resection of the body/tail of the pancreas, as well as the spleen

Question 39

When is distal pancreatotomy recommended?

Answer 39

It is recommended in cases where malignancy is confined to the body/tail of the pancreas

Question 40

What is total pancreatotomy?

Answer 40

It involves resection of the whole pancreas, as well as the duodenum, common bile duct, gallbladder and spleen

Question 41

When is total pancreatotomy recommended?

Answer 41

It is recommended in cases where malignancy is diffuse or confined to pancreas, involving the neck region

Question 42

How is ERCP used to manage pancreatic cancer?

Answer 42

It can be used to insert a sent into the bile duct to relieve compression caused by pancreatic cancer This enables drainage of bile

Question 43

When is ERCP recommended as a management option?

Answer 43

It is used as a palliative management option to provide symptomatic relief

Question 44

How is chemotherapy used to manage pancreatic cancer?

Answer 44

It can be administered adjuvantly, in combination with management techniques to improve the likelihood of success