Pancreatic Cancer Flashcards
What is the most common type of pancreatic cancer?
Adenocarcinoma - ductal epithelium (exocrine) = 85%
What are the different classifictions of pancreatic cancer?
Can affect exocrine or endocrine cells
What is the pathophysiological process underpinning the development of gastric cancer?
Genes = KRAS, TP53, CDKN2A, SMAD4
Unregulated cell growth = precursor lesions known as intraepithelial neoplasia
Continued acquisition of genetic mutations -> invasive carcinoma.
Cell signalling pathways affected: MAPK, PI3K-AKT, dysregulation in the TGF-beta signalling pathway.
What nearby structures does pancreatic cancer commonly invade?
Why is this problematic?
Bile duct = obstructive jaundice
Duodenum = gastric oultet obstruction
Splanchnic nerves = severe, intractable pain
Where does pancreatic cancer tend to metastasise?
Highly metastatic early in disease
Liver, peritoneum, lungs and regional lymph nodes
What are the risk factors for pancreatic cancer?
70yrs+
Males
African American and Ashkenazi Jews (BRCA2 mutations)
FH – Peutz Jeghers syndrome, familial atypical multiple mole melanoma syndrome, Lynch syndrome or BRCA2 gene mutations.
Smoking
Diet – high in processed meat and low in fruits and vegetables
Obesity and physical inactivity
Alcohol consumption – alcoholic pancreatitis
Chronic pancreatitis – hereditary or alcoholic.
Diabetes Mellitus (stronger for type 2)
What are the typical signs and symptoms of pancreatic cancer?
Weight loss
Jaundice (head lesions) - painless
Abdominal pain – radiating to the back
Anorexia
Malaise
Loss of exocrine function = steatorrhea
Loss of endocrine function = diabetes mellitus
Migratory thrombophlebitis = Trousseau syndrome
Insidious and non-specific
What are the key investigations for pancreatic cancer?
Abdo ultrasound - tumours >2cm, liver mets and dilation of CBD
CT AP - high clinical suspcisoin, for surgical planning and staging
MRCP - if concerned about biliary ducts
Endo ultrasound and biopsy for small lesions
PET-FDG and MRI as adjucnts
What is the NICE 2ww referral pathway for pancreatic cancer?
40yrs+ and jaundice
Consider urgent 2week CT if 60yrs+, weight loss and any of the following: diarrhoea, back pain, abdo pain, nausea, vomiting, constipation, or new onset diabetes.
What are the criteria for curative surgical resection of pancreatic cancer?
No evidence of SMA or coeliac artery involvement
No evidence of distant mets
(only 15-20% tend to qualify)
What is the common surgical procedure for pancreatic cancer?
Kausch-Whipple procedure for head of pancrease tumours (radical pancreaticoduodenectomy)
Adjuvant chemo to follow post op if recovering well.
What are the palliative treatment options for pancreatic cancer?
Endoscopic stent into CBD
Palliative surgery
Chemotherapy
Radiotherapy (localised advanced disease only)
What is the prognosis for pancreatic cancer?
Insidious and non-specific = delayed until advanced stages.
5yr survival under 10%
