Pancreatic Cancer

Question 1

Where do most pancreatic cancers occur and what type of cancer are they?

Answer 1

80% adenocarcinomas in head of pancreas

Question 2

Associations of pancreatic cancer

Answer 2

• age
• smoking
• diabetes
• chronic pancreatitis
• HNPCC
• MEN - multiple endocrine neoplasia
• BRCA2 gene
• KRAS gene mutation

Question 3

Clinical features of pancreatic cancer

Answer 3

• painless jaundice
• pale stools
• dark urine
• pruritus
• hepatomegaly (mets)
• weight loss
• loss of exocrine function (steatorrhoea)
• loss of endocrine function (diabetes)

Question 4

Describe the appearance of LFTs in pancreatic cancer

Answer 4

cholestatic

Question 5

Investigations to detect pancreatic cancer

Answer 5

AUSS usually first line Ix
- 60-90% sensitivity

high-resolution CT pancreas = gold standard

Question 6

Common finding on CT pancreas indicating pancreatic cancer

Answer 6

‘double duct’ sign

• simultaneous dilatation of the common bile and pancreatic ducts

Question 7

Management of pancreatic cancer

Answer 7

<20% are suitable for surgery at diagnosis

• Whipple’s (pancreaticoduodenectomy) for resectable lesions in the head of pancreas.
• adjuvant chemotherapy is usually given following surgery
• ERCP with stenting = used for palliation
• palliative chemotherapy