Pancreatic Cancer Flashcards
Define pancreatic cancer. what are the types? Which is most common?
80% of pancreatic cancer are unresectable at diagnosis. What is the mean age of onset of pancreatic cancer? What is the survival?
What are the RFs for pancreatic cancer? (5)
Describe the pathophysiology of pancreatic cancer. What are common sites of invasion/ disseminated disease.
Is pancreatic cancer typically painful or painless
Painless (courvoisier’s law)
But in many situations it is painful and even irretractable pain due to the chronic pancreatitis (remember pancreatic Ca is both a cause and a complication of chronic pancreatitis)
List the common symptoms of pancreatic cancer.
Also add in local invasion to the duodenum (SBO), biliary tree, gastric outlet obstruction and transverse colon (LBO/closed loop obstruction)
+ metastasis => lung, liver, etc…
What is courvoisier’s law?
In the presence of a palpable, non-tender gallbladder and jaundice, the cause is unlikely to be gallstones and is more likely due to a malignancy, such as pancreatic or biliary tract cancer.
What is thrombophlebitis migrans?
How does it feel palpation?
Thrombophlebitis migrans, also known as migratory thrombophlebitis, is a medical condition characterised by recurrent, migrating inflammation and thrombosis (clot formation) of superficial veins. It is often associated with underlying systemic conditions, particularly malignancy.
TENDER AND FIRM on palpation
List the common signs of pancreatic cancer.
List some ddx for pancreatic ca.
What is the tumour marker for pancreatic cancer?
CA 19-9
Why would you order a CA-19-9 when suspecting pancreatic Ca?
Also raised in other cancers such as cholangiocarcinoma.
It assesses response to treatment rather than for initial diagnosis. Ordered in the beginning to establish baseline prior to treatment
Give the diagnostic investigations + staging for pancreatic Ca
Diagnostic: ERCP for core biopsy or Endoscopic US for FNA
Staging: CT pancreas protocol -> CTTAP -> PET CT FDG
+!!! Staging laparoscopy for peritoneal involvement
Give your full list of investigations for Pancreatic Ca
What % of patients with pancreatic cancer will have palloiative care? What are the palliative managements available to patients with pancreatic cancer.
80% unresectable => 80% palliative care.
Also, ERCP (cut off) for Stent placement which can be escalated to gastrojejunostomy or Pancreaticojejunostomy.
Outline you management plan for pancreatic cancer.
