Pancreatic Cancer Flashcards
What is the most common type of pancreatic cancer?
Ductal carcinoma
Others - endocrine/exocrine
What is the pathophysiology of pancreatic carcinoma?
Direct invasion of local structures as the cancer spreads - spleen, transverse colon, adrenal glands.
Lymph metastasis involves regional lymph nodes, liver, lungs and peritoneum
MEtastesize early, present late
Mostly arise in pancreatic head some in body and tail.
What are risk factors for pancreatic carcinoma?
Smoking Alcohol Carcinogens Diabetes mellitus Chronic pancreatitis Late onset diabetes High waist circumference
What is the clinical presentation of the head of pancreas cancer patient?
Painless obstructive jaundice - due to compression of the common bile duct
What is the clinical features of pancreatic cancer?
Body and tail - epigastric pain (radiates to the back and relieved by sitting forward)
Weight loss - due to metabolic effects of cancer or secondary to exocrine dysfunction
Anorexia, diabetes, acute pancreatitis
Less common : thormbophlebitis migrant (a recurrent smigratory superficial thrombophlebitis caused by paraneoplastic hypercoagulable state
What are signs of pancreatic cancer
Jaundice + palpable gallbladderEpigastric mass Hepatomegaly Splenomegaly Lymphadenopaathy Ascites
What is Courvoisier’s Law?
In the presence of jaundice and an enlarged/palpable gallbladder, malignancy of the biliary tree or pancreas should be strongly suspected as cause is unlikely to be gallstones. Sign may be present if obstructing tumour is distal to the cystic duct.
What are differentials for obstructive jaundice and epigastric pain?
OJ -gallstone disease, cholangiocarcinoma, benign gallbladder stricture
Epigastric pain - gallstones, PUD, pancreatitis, AAA, gastric carcinoma, ACS
What investigations for pancreatic cancer?
Bloods: FBC (anaemia or thrombocytopenia)
LFTs (raise bilirubin, Alkaline phosphatase and gamma-GT showing obstructive jaundice)
CA19-9 is tumour marker for pancreatic cancer
Imaging:
Abdominal USS - pancreaticc mass or dilated biliary tree
Pancreatic protocol CT - most important for staging
Endoscopic USS - used to guide fine needle aspiration biopsy - ERCP can also be used to assess lesion for biopsy/cytology
What is the management for pancreatic carcinoma?
Surgical - Resection
- head of pancreas tumour - pacreaticoduodenectomy - Whipple’s procedure
- body or tail of pancreas - distal pancreatectomy
Contraindications for surgery: peritoneal, liver and distant metastases
Post-operative Chemotherapy
- delays disease progression
Palliative:
Insertion of biliary stent for obstructive jaundice
Palliative chemotherapy
Enzyme replacements for exocrine insufficiency –> malabsorption and steatorrhoea
Pain management - opioids
Describe the Whipple’s procedure
Removal of:
Head of pancreas, antrum of stomach, 1st and 2nd parts of duodenum, common bile duct and gallbladder.
(all have common arterial supply - gastroduodenal artery)
Tail of pancreas and hepatic duct are attached to the jejunum allowing bile and pancreatic juices to drain into the gut while the stomach is anastomosed with the jejunum allowing for passage of food.
What is the difference between functional and non-functional endocrine tumours?
Functional - secrete hormones actively and signs and symptoms relate to this.
Non-functional do not secrete active hormones and clinical features are related to malignant spread
