Pancreatic Cancer Flashcards
What are the two main types of pancreatic cancer?
1) exocrine (99%)
2) neuroendocrine (1%)
In which patient demographic is pancreatic cancer most common?
Males over the age of 60
Give 8 risk factors for pancreatic cancer:
1) smoking
2) high alcohol intake
3) chronic pancreatitis
4) high coffee intake
5) diabetes
6) excessive use of aspirin
7) family history
8) associated mutations
Give 2 genetic mutations associated with increased risk of pancreatic cancer:
1) PRSS-1
2) BRCA-2
What type of tumours are seen in exocrine pancreatic cancer?
Adenocarcinoma
Where in the pancreas is tumour formation most common?
head
Describe the pathogenesis of pancreatic cancer: (3)
- Accumulation of gene mutations lead to pancreatic intraepithelial neoplasia (panIN)
- this panIN progresses to an invasive carcinoma through the accumulation of mutations
- once the tumour is large enough, it can compress the bile duct, resulting in obstructive jaundice
Give 4 genetic mutations that are commonly seen in pancreatic intraepithelial neoplasia:
1) KRAS
2) CKDN2A
3) p53
4) SMAD
Give 4 organs that pancreatic cancer commonly metastasises to:
- Liver
- Peritoneum
- lungs
- bones
What is the average survival time for pancreatic cancer?
6 months
What are the two most indicative clinical features of pancreatic cancer?
1) obstructive jaundice symptoms
2) weight loss
Give 4 symptoms of obstructive jaundice:
1) yellow skin and sclera
2) pale stools
3) dark urine
4) generalised itching
Give 6 general symptoms of pancreatic cancer:
1) abdominal pain that may radiate to the back
2) anorexia and weight loss
3) palpable mass in the epigastric region
4) change in bowel habit
5) nausea or vomiting
6) new-onset diabetes or worsening of type 2 diabetes
Give two named signs associated with pancreatic cancer:
1) Courvoisier’s sign
2) Trousseau’s sign of malignancy
What is Courvoisier’s sign?
palpable gall bladder caused by an obstructed bile duct seen in pancreatic cancer
What is Trousseau’s sign of malignancy?
recurring thrombophlebitis (where blood vessels become inflamed with an associated thrombus in the area) which reoccurs in multiple locations over time
Give the NICE guidelines for pancreatic cancer referral:
1) over 40 with jaundice -> 2 week wait referral
2) over 60 with weight loss and any of diarrhoea, back pain, abdominal pain, nausea, vomiting, constipation or new onset diabetes -> direct access CT abdomen
What two methods are used to diagnose pancreatic cancer?
- Imaging
- Histology via biopsy
What is CT TAP?
full CT including thorax, abdomen and pelvis
Name 3 imaging techniques for pancreatic cancer:
1) CT TAP
2) magnetic resonance cholangio-pancreatography (MRCP)
3) transabdominal ultrasound