Pancreatic Cancer (2)

Question 1

What is its most common type?
→ What does this lead to?

What are its risk factors?

Answer 1

➊ Adenocarcinomas at the head of the pancreas
→ Compression of the bile duct, leading to Obstructive Jaundice

➋ • Smoking, Alcohol, Chronic Pancreatitis, T2DM, Obesity
• Age, Family hx of pancreatic ca.
• KRAS2 mutation (95%)

Question 2

What’s its main presenting symptom?
→ What’s the key differential with this symptom?

How else does it present?

What type of paraneoplastic syndrome occurs here?

Answer 2

➊ Painless, obstructive jaundice
→ Cholangiocarcinoma

➋ • Epigastric pain
• New-onset Diabetes (or worsening of it)
• Steatorrhoea
• Unintentional weight loss
• Courvoisier’s Law - Palpable gallbladder + jaundice is unlikely to be due to gallstones, and is usually due to a cholangio/pancreatic ca.

➌ Trousseau’s syndrome – Migratory thrombophlebitis affecting the extremities of the body

N.B. Often presents very late due to its non-specific symptoms of malaise, weight loss, and nausea

Question 3

What are the investigations to do?

How is it managed?

Answer 3

➊ • Abdomen USS - Good at detecting tumours at head, but not body/tail so a -ve result doesn’t rule out ca.
• CT
• CA19-9
• MRCP/ERCP

➋ • Palliative - stenting, chemoradiotherapy
• Curative - Whipples procedure