Pancreatic cancer

Question 1

What type of cancer are most pancreatic tumours?

Answer 1

Adenocarcinomas

Question 2

Where do most pancreatic cancers occur?

Answer 2

In the head of the pancreas

Question 2

What is the presentation of pancreatic cancer?

Answer 2

Painless obstructive jaundice
- Yellow skin and sclera
- Pale stools
- Dark urine
- Generalised itching
Upper abdominal pain
Unintentional weight loss
Change in bowel habit
Nausea and vomiting
New-onset diabetes

Question 3

What are the risk factors for pancreatic cancer?

Answer 3

Increasing age
Male
Smoking
Diabetes
Chronic pancreatitis
Multiple endocrine neoplasia
Genetics - hereditary non-polyposis colorectal carcinoma, BRCA1 and BRCA2 mutations

Question 4

When should patients be referred on a 2 week wait for pancreatic cancer?

Answer 4

Over 40 with jaundice
Over 60 with weight loss plus an additional symptom:
- Diarrhoea
- Back pain
- Abdominal pain
- Nausea or vomiting
- Constipation
- New onset diabetes

Question 5

What is Courvoisier’s law?

Answer 5

A palpable gallbladder with jaundice is unlikely to be gallstones - it is usually cholangiocarcinoma or pancreatic cancer

Question 6

What investigations are diagnostic of pancreatic cancer?

Answer 6

CT pancreas
Histology from biopsy

Question 7

What other investigations are useful in the diagnosis of pancreatic cancer?

Answer 7

LFTs
CA19-9
Staging CT scan - CT TAP
MRCP - assess obstruction of biliary system
ERCP - relieve obstruction and obtain biopsy

Question 8

What is the management of localised pancreatic cancer?

Answer 8

Surgery
- Total pancreatectomy
- Distal pancreatectomy
- Whipple’s procedure

Question 9

What is removed during a whipple’s procedure?

Answer 9

Head of the pancreas
Pylorus of stomach
Duodenum
Gallbladder
Bile duct
Relevant lymph nodes

Question 10

What palliative treatment is available for pancreatic cancer?

Answer 10

ERCP with stenting
Palliative chemotherapy
Palliative radiotherapy