Pancreatic Cancer

Question 1

80% of pancreatic tumours are what type of cancer and where do thy occur ?

Answer 1

head of the pancreas

Question 2

risk factors for pancreatic cancer ?

Answer 2

increasing age

smoking

diabetes

chronic pancreatitis (alcohol does not appear an independent risk factor though)

hereditary non-polyposis colorectal carcinoma

multiple endocrine neoplasia

BRCA2 gene

KRAS gene mutation

Question 3

features of pancreatic cancer ?

Answer 3

painless jaundice
- pale stools (steatorrhea), dark urine, and pruritus

following abdominal masses may be found (in decreasing order of frequency)

hepatomegaly: due to metastases

gallbladder: Courvoisier’s law states that in the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones

epigastric mass: from the primary tumour

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norexia, weight loss, epigastric pain

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oss of endocrine function (e.g. diabetes mellitus)

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migratory thrombophlebitis (Trousseau sign) is more common than with other cancers

Question 4

diagnosis of pancreatic cancer ?

Answer 4

cholestatic liver function tests

high-resolution CT scanning is the investigation of choice if the diagnosis is suspected
- imaging may demonstrate the ‘double duct’ sign - the presence of simultaneous dilatation of the common bile and pancreatic ducts

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ultrasound has a sensitivity of around 60-90%

Question 5

management ?

Answer 5

a Whipple’s resection (pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas

adjuvant chemotherapy is usually given following surgery

ERCP with stenting is often used for palliation

Question 6

side effects of Whipple’s resection

Answer 6

dumping syndrome - group of symptoms, such as diarrhea, nausea, and feeling light-headed or tired after a meal, that are caused by rapid gastric emptying

peptic ulcer disease