Pancreatic cancer Flashcards

1
Q

Define pancreatic cancer.

A

Malignancy arising form the endocrine or exocrine tissues of the pancreas.

Usually pancreatic ductal adenocarcinoma, (>85%) presenting with painless jaundice and weight loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for pancreatic cancer?

A

Unknown cause

FH (10%) - hereditary syndromes include…

  • BRCA2 mutation
  • familial atypical multiple mole melanoa (CDKN2A)
  • Peutz-Jeghers (STK11/LKB1)
  • hereditary pancreatitis (PRSS1)
  • MEN
  • HNPCC
  • FAP
  • Gardner
  • von Hippel-Lindau syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the pathophysiology of pancreatic cancer?

  • where do most occur
  • where does it spread to
  • what cell type do most pancreatic cancers affect
A
  • 75% occur in head/neck of the pancreas (periampullary tumour)
  • 15-20% occur in the body and 5-10% occur in the tail
  • Spread is local and to the liver
  • 80% adenocarcinomas, others adenosquamous, mucinous cystadenocarcinomas, or endocrine tumours (insulinomas, gucagonomas, gastrinomas)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name 3 types of pancreatic cancer precursor lesions.

A

Precursor lesions include

  1. pancreatic intraepithelial neoplasia (PanIN)
  2. intraductal papillary mucinous neoplasm
  3. mucinous cystic neoplasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the epidemiology of pancreatic cancer?

A
  • Poor prognosis
  • Cancer of old people - peak age 60-80years
  • M>F 2:1
  • 4th most common cause of cancer-related deaths in UK
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the typical presentation of pancreatic cancer?

A
  • Initial symptoms are non-specific - anorexia, malaise, weight loss, nausea.
  • Later jaundice, epigastric pain.

Uncommon symptoms: thirst, polyuria, nocturia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the signs of pancreatic cancer on examination?

A
  • Weight loss, epigastric tenderness or mass
  • Jaundice and palpable gall bladder (Courvoisier’s law)
  • Hepatomegaly (if metastatic spread)
  • Trousseau’s sign is associated with superficial thrombophlebitis
  • Other: petechiae, purpura, bruising (DIC in advanced disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What investigations would you do for pancreatic cancer?

A

Diagnosis:

  • Abdo USS - may show pancreatic mass or dilated biliary tree
  • CT imaging - GOLD standard for diagnosis and prognosis/ staging
  • PET-CT/MRCP - if diagnosis unclear
  • CT CAP - staging
  • Endoscopic ultrasound +/- FNA - for tissue biopsy staging

Other:

  • Tumour markers CA19-9, CEA - high but neither diagnostic
  • High bilirubin, high ALP, high GGT - if obstructive jaundice
  • Deranged clotting - high PT
  • FBC - low platelets in DIC, anaemia in GI bleed
  • Staging laparoscopy - identified peritoneal, capsular or serosal involvement or small hepatic metastases not seen on CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What tumour marker is associated with pancreatic cancer? What is its use?

A

CA19-9 is a tumour marker for pancreatic carcinoma

  • High sensitivity and specificity
  • Main role is in assessing response to treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which of these are true about pancreatic cancer? (3)

  • Cigarette smoking is a risk factor
  • Diabetes is a risk factor
  • Tumours are most common in the tail of the duct gland.
  • Encasement of the superior mesenteric vessels does not preclude surgery
  • Most lesions arise from exocrine ductal epithelium
  • In patients not suitable for surgery, a good response can be expected from chemoradiotherapy.
A
  • Cigarette smoking is a risk factor
  • Diabetes is a risk factor
  • Most lesions arise from exocrine ductal epithelium

Few patients are suitable for surgery and vessel encasement is a contraindication. 1 year survival rates are very poor. Most tumours occur in the head of the gland.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the management of pancreatic cancer?

A

Pancreaticoduodenectomy with antrectomy (Whipple’s) +/- regional lymphadenectomy - if tumour at head of pancreas

Distal pancreatectomy +/- splenectomy with regional lymphadenectomy - for body or tail of pancreas tumours

Adjuvant chemotherapy - for all patients, prolongs survival

Other:

Pancreatic enzyme replacement - Creon

Internal biliary stenting - if obstructive symptoms >10days post-op

Analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the prognosis with pancreatic cancer?

A

Stage I/II - only 10-15% have resectable disease and median survival is 15-19months

Stage III/unresectable - poor prognosis with chemo/radiotherapy only having a modest improvement in survival

Stage IV/metastatic - 3-6 month survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the complications of pancreatic cancer?

A
  • Cholangitis
  • DVT
  • PE
  • Obstruction
  • Surgery related: bleeding, pancreatic leaks, fistula, delayed gastric emptying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is shown?

A

Pancreaticoduodenectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly