Pancreatic cancer

Question 1

Pancreatic cancer?

Answer 1

• Pancreatic cancer is often diagnosed late as it tends to present in a non-specific way.
• Over 80% of pancreatic tumours are adenocarcinomas which typically occur at the head of the pancreas.

Question 2

Associations?

Answer 2

• increasing age
• smoking
• diabetes
• chronic pancreatitis (alcohol does not appear an independent risk factor though)
• hereditary non-polyposis colorectal carcinoma
• multiple endocrine neoplasia
• BRCA2 gene

Question 3

Features?

Answer 3

• classically painless jaundice
• however, patients typically present in a non-specific way with anorexia, weight loss, epigastric pain
• loss of exocrine function (e.g. steatorrhoea)
• atypical back pain is often seen
• migratory thrombophlebitis (Trousseau sign) is more common than with other cancers

Question 4

Investigation?

Answer 4

• ultrasound has a sensitivity of around 60-90%
• high resolution CT scanning is the investigation of choice if the diagnosis is suspected

Question 5

Management?

Answer 5

• less than 20% are suitable for surgery at diagnosis
• a Whipple’s resection (pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas. Side-effects of a Whipple’s include dumping syndrome and peptic ulcer disease
• adjuvant chemotherapy is usually given following surgery
• ERCP with stenting is often used for palliation

Question 6

ERCP showing invasive ductal adenocarcinoma. Note the dilation of the common bile duct due to the pancreatic lesion

Answer 6