Pancreatic cancer

Question 1

Epidemiology

Answer 1

• 4th commonest cancer
• 80% betwen 5th and 6th decade

Question 2

Risk factors

Answer 2

• smoking
• increasing age
• high fat diet
• DM
• excessive alcoholism
• chronic pancreatitis
• herediaty 1in 20 FH

Question 3

Patholgical features

Answer 3

• ninety per cent ductal adenocarcinom
• seven per cent mucinous cystic neoplasms
• three per cent islet cell tumours

Question 4

Symptoms

Answer 4

• painless jaundice
• weight loss
• nausea/vomitting
• upper abdominal pain radiating to back

Question 5

Investigations

Answer 5

• Liver function (obstructive jaundice)
• Elevated Ca 19-9
• Ultrasound
• CT scan + guided FNA/ Biopsy
• ERCP
• Endocscopic ultrasoun + guided FNA/Biopsy

Question 6

treatment

Answer 6

curative- surgery- if localised to pancreas with no evidence of local or distant invasion

1. whipples
2. distal pancreatectomy (depends on the site of tumour)

Palliative

1. chemo
2. stenting of bile duct
3. surgical bypass of duodeonal obstruction