Pancreatic Cancer Flashcards
a mutation in which proto-oncogene is associated with pancreatic cancer?
K-RAS2
what percentage of pancreatic cancers are exocrine tumours?
95%
what are the risk factors for pancreatic cancer?
- age >75
- blood group A
- smoking
- obesity
- alcohol
- red/processed meat
- ionising radiation
- acrylamide
- diabetes
- chronic pancreatitis
painless, obstructive jaundice is due to what until proven otherwise?
pancreatic cancer
how does the anatomical location of a pancreatic tumour affect its presentation?
- 65% head/neck of the pancreas – tend to present earlier with obstructive jaundice
- 15% body/tail of the pancreas – tend to present later + have a worse prognosis
- 15% diffuse or multicentric involvement of the whole pancreas
why does a tumour of the head or neck of the pancreas cause obstructive jaundice?
compression of the CBD
what are the symptoms of pancreatic cancer?
- dark urine
- pale stools
- anorexia
- malaise
- weight loss
- vague abdominal or back pain
what are the symptoms of pancreatic cancer in the advanced stages of disease?
- nausea
- vomiting
- fatigue
- portal hypertension
- signs of metastases (e.g. RUQ pain, SOB, abdominal distension, subcutaneous nodules)
what are the features of pancreatic cancer on abdominal examination?
- epigastric tenderness
- upper abdominal mass
- palpable gallbladder
- nodular hepatomegaly
- ascites
what is courvoisier’s law?
states that in the presence of painless jaundice and a palpable gallbladder, the cause is more likely to be malignant obstruction (e.g. pancreatic cancer) rather than gallstones
what tumour marker is useful in the diagnosis and monitoring of pancreatic cancer?
CA19-9
>100 units/mL is suggestive of pancreatic cancer
- >1000 units/mL is strongly associated with advanced unresectable disease
what imaging may be used to diagnose pancreatic cancer?
- US/CT abdomen
- endoscopic US (EUS) + FNA
- ? MRCP/ECRP
what is the gold-standard imaging modality for assessing pancreatic cancer?
- triple-phase ‘pancreas protocol’ CT
- it takes images at different times after IV contrast administration, providing detailed imaging of the tumour, local tissue invasion, vascular infiltration, biliary dilatation, and lymphatic or liver metastases
what are the methods of obtaining biopsies for histopathology in pancreatic cancer?
- percutaneously
- endoscopically (e.g. EUS/ERCP)
- laparoscopically
- open
endoscopic biopsy is considered to be the safest approach
what is the curative surgical procedure for localised tumours in the head of the pancreas or periampullary region?
pylorus-preserving pancreaticoduodenectomy (‘modified whipple’), which involves the removal of the:
- head of the pancreas
- part of the duodenum
- CBD
- gallbladder
a roux-en-Y loop from a segment of jejunum is used to restore continuity of the gastrointestinal tract:
- pancreaticojejunostomy
- hepaticojejunostomy
- duodenojejunostomy
what is a distal pancreatectomy?
- patients with localised tumours in the body or tail of the pancreas are suitable for a distal pancreatectomy
- this involves the removal of the body and tail of the pancreas as well as the spleen
what is a total pancreatectomy?
- rarely, patients with localised tumours in or involving the neck of the pancreas, or diffuse cancers (e.g. IPMN), may be offered a total pancreatectomy
- this combines a ‘modified whipple’ and a distal pancreatectomy
what adjuvant chemotherapy is recommended for patients undergoing curative surgical treatment of pancreatic cancer?
a gemcitabine-based adjuvant chemotherapy regimen post-operatively
how are unresectable or metastatic functional endocrine pancreatic tumours managed medically?
somatostatin analogues (e.g. octreotide + lanreotide) control symptoms by suppressing pancreatic hormone secretion
*excluding somatostatinomas
