Pancreatic Cancer Flashcards
Why does pancreatic cancer have poor prognosis?
Often diagnosed very late
5 year survival 25%
What are the majority of pancreatic cancers?
Adenocarcinomas
Where do most pancreatic cancers occur?
Head of the pancreas, can compress bile ducts causing obstructive jaundice
What is the average survival of pancreatic cancer when diagnosed with advanced disease?
6 months
Pancreatic cancers metastasise early and spread particularly to the liver, peritoneum, lungs and bones
How does pancreatic cancer present?
Painless obstructive jaundice
Yellow skin and sclera
Pale stools
Dark urine
Generalised itching
What are some vague presenting symptoms of pancreatic cancer?
Non-specific upper abdominal or back pain
Unintentional weight loss
Palpable epigastric mass
Change in bowel habit
Nausea
New-onset diabetes or worsening of type 2 diabetes
What are the NICE guidelines for suspected pancreatic cancer?
Over 40 with jaundice- 2 week wait referral
Over 60 with weight loss + vague symptom- direct access CT abdomen
Only case where GPs can refer directly for CT scan
What are the named signs of pancreatic cancer?
Courvoisier’s law
Palpable gallbladder with jaundice likely to be cholangiocarcinoma or pancreatic cancer
Trousseau’s sign of malignancy
Migratory thrombophlebitis, sign of pancreatic adenocarcinoma
Inflammation of blood vessels, clot forms in local area which occurs in different areas over time
What investigations are used for pancreatic cancer?
Staging CT
CA19-9
MRCP
ERCP
Biopsy
How is pancreatic cancer managed?
- Surgery to remove tumour (if isolated to head, 10%)
- Total pancreatectomy
- Distal pancreatectomy
-Pylorus-preserving pancreaticoduodenectomy (PPPD, modified Whipple procedure) - Radical pancreaticoduodenectomy
What is done in palliative treatment of pancreatic cancer?
Stents
Surgery to improve symptoms
Palliative chemotherapy and radiotherapy
End of life care with symptom control
What is a Whipple Procedure?
Removal of a tumour of the head of the pancreas that has not spread
Massive operation, patients need good baseline health
What is removed in a Whipple Procedure?
Head of the pancreas
Pylorus of the stomach
Duodenum
Gallbladder
Bile duct
Lymph nodes
Modified Whipple preserves the pylorus