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Z - Cancer Care Old > Pancreatic Cancer > Flashcards

Pancreatic Cancer Flashcards

1
Q

How common is pancreatic cancer relative to other cancers?

A

It is the tenth most common cancer in the UK

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2
Q

How common is death from pancreatic cancer, compared to other cancers?

A

It is the 5th most common cause of cancer death

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3
Q

What is the average age of diagnosis of pancreatic cancer?

A

60-65

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4
Q

Which gender is pancreatic cancer more common in?

A

Males before 75, women after 75

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5
Q

What is the only well established aetiological factors in the development of pancreatic cancer?

A

Smoking

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6
Q

By how much does smoking increase the risk of pancreatic cancer?

A

5x

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7
Q

What are some potential risk factors for pancreatic cancer?

A
  • Alcohol
  • Coffee
  • Diabetes mellitus
  • Chronic pancreatitis
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8
Q

What is the problem with alcohol and coffee as risk factors for pancreatic cancer?

A

Studies have been contradictory

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9
Q

What is the problem with diabetes mellitus and chronic pancreatitis as risk factors for pancreatic cancer?

A

Both may develop as a consequence of pancreatic cancer, so the results have been questioned

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10
Q

What are the types of pancreatic cancer?

A
  • Adenocarcinoma of ductal origin
  • Endocrine tumours arising from islet cells
  • Acinar cell tumours
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11
Q

What % of cases of pancreatic cancer are adenocarcinomas of ductal origin?

A

90%

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12
Q

What % of cases of pancreatic cancer are endocrine tumours arising in islet cells?

A

5%

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13
Q

What % of cases of pancreatic cancer are acinar cell tumours?

A

5%

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14
Q

What proportion of pancreatic cancers occur in the head of the pancreas?

A

2/3

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15
Q

How do pancreatic tumours occurring in the head of the pancreas present?

A
  • Epigastric pain
  • Weight loss
  • Jaundice
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16
Q

What proportion of pancreatic cancers occur in the tail and body of the pancreas?

A

1/3

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17
Q

How do pancreatic tumours occurring in the tail and body of the pancreas present?

A
  • Pain in the left upper quadrant of abdomen

- Constipation

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18
Q

Why do pancreatic tumours occurring in the tail and body of the pancreas present with constipation?

A

Due to colonic involvement

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19
Q

What happens to the pain caused by pancreatic cancer of the tail or body over time?

A

It increases in severity and radiates to the back

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20
Q

What does the radiation of the pain caused by pancreatic cancer of the body or tail co-incidence with?

A

Retroperitoneal invasion

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21
Q

When does the pain from pancreatic cancer of the body or tail characteristically improve?

A

When the patient leans forwards

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22
Q

What has a better prognosis, pancreatic tumours of the head, or of the body or tail?

A

Of the head

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23
Q

Why do pancreatic tumours of the body or tail have a worse prognosis?

A

Because they tend to be larger at diagnosis, and therefore have a worse prognosis

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24
Q

When might pancreatic cancers cause obstructive jaundice at an early stage?

A

When they are periampullary

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25
Q

What is the result of periampullary pancreatic tumours causing obstructive jaundice at an early stage?

A

Can result in an earlier diagnosis, and therefore the tumours have a better outcome

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26
Q

Where might pancreatic tumours extend into?

A
  • Duodenum
  • Stomach
  • Retroperitoneum
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27
Q

What do pancreatic tumours that present late often have involvement of?

A

Locoregional lymph nodes, particularly para-aortic and portal

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28
Q

What are the common sites of metastasis in pancreatic cancer?

A
  • Liver

- Lung

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29
Q

When are many patients asymptomatic up until?

A

The common bile duct becomes blocked, and they become jaundiced

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30
Q

What are the rarer presentations of pancreatic cancer?

A
  • Splenomegaly

- Varices

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31
Q

How can pancreatic cancer cause splenomegaly and varices?

A

Splenic vein occlusion by a tumour in the body or tail of the pancreas

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32
Q

What might be the presenting feature of pancreatic malignant months before any other signs or symptoms emerge?

A

Diabetes mellitus

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33
Q

What are the other presenting features of pancreatic cancer?

A
  • Trousseau sign of malignancy
  • Fever
  • Ascites
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34
Q

What is Trousseau sign of malignancy?

A

Superficial migratory thrombophlebitis

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35
Q

What causes fever in pancreatic cancer?

A

Cholangitis

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36
Q

What causes ascites in pancreatic cancer?

A

Peritoneal involvement

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37
Q

What lymph nodes should be examined in pancreatic cancer?

A
  • Neck
  • Supraclavicular
  • Axillary
  • Paraaortic
38
Q

What should be looked for on abdominal examination in pancreatic cancer?

A
  • Mass in epigastrum
  • Mass in left hypochondrium
  • Visible peristalsis
  • Bowel obstruction
  • Abdominal distention
  • Ascites
  • Hepatomegaly
  • Splenomegaly
39
Q

Who should early pancreatic cancer be considered in?

A

Any individual with ongoing upper abdominal pain

40
Q

What is investigation aimed at in pancreatic cancer?

A
  • Establishing prognosis

- Defining operability

41
Q

What kind of ultrasound is used in pancreatic cancer investigation?

A

Endoluminal ultrasound

42
Q

What is the advantage of endoluminal ultrasound over abdominal ultrasound in pancreatic cancer?

A

It can produce clearer images

43
Q

Why does endoluminal ultrasound produce clearer images in pancreatic cancer?

A

Because it is passed down the oesophagus, so achieves closer proximity to the pancreas

44
Q

What can CT imaging reveal in pancreatic cancer?

A
  • Mass
  • Evidence of invasion
  • Lymph node involvement
  • Metastasis
45
Q

Is ERCP required in pancreatic cancer?

A

Yes

46
Q

What can be performed during ERCP in pancreatic cancer?

A
  • Brushings
  • Suction of the pancreatic duct
  • Biopsy
  • Stenting
47
Q

What should failure to obtain a diagnosis by ERCP be followed by?

A
  • Image-guided biopsy by FNA

- Laparoscopic biopsy or assessment

48
Q

What blood tests should be done in pancreatic cancer?

A
  • FBC
  • Renal and liver funtion
  • Serum CA19-9
49
Q

What staging system is used in pancreatic cancer?

A

TNM

50
Q

How can pancreatic cancer be grouped practically?

A

If it resectable, locally advanced (non-resectable), or metastatic at presentation

51
Q

What is Tis in pancreatic cancer?

A

Carcinoma in situ

52
Q

What is T1 in pancreatic cancer?

A

Tumour has not spread beyond the pancreas, and is smaller than 2cm

53
Q

What is T2 in pancreatic cancer?

A

Tumour has not spread beyond the pancreas, but is larger than 2cm

54
Q

What is T3 in pancreatic cancer?

A

Tumour has spread from the pancreas to surrounding tissues near the pancreas, but not to major blood vessels or nerves

55
Q

What is T4 in pancreatic cancer?

A

Tumour has extended beyond the pancreas and invades nearby large blood vessels or nerves

56
Q

What is N0 in pancreatic cancer?

A

Regional lymph nodes are not involved

57
Q

What is N1 in pancreatic cancer?

A

Regional lymph nodes are involved with the tumour

58
Q

What is M0 in pancreatic cancer?

A

Tumour has not spread to distant lymph nodes (other than those near the pancreas, or to distant organs such as the liver, lungs, or brain

59
Q

What is M1 in pancreatic cancer?

A

Distant metastases are present

60
Q

What proportion of patients present with pancreatic cancer so advanced that the only treatment options are palliative?

A

1/3

61
Q

What are the palliative care approaches in advanced pancreatic cancer?

A
  • Pain relief

- Symptom control

62
Q

How can jaundice be managed in palliative care for pancreatic cancer?

A

Endoscopic stenting

63
Q

How can duodenal obstruction be managed in palliative care for pancreatic cancer?

A

Surgical gastric bypass

64
Q

How can pain be managed in palliative care for pancreatic cancer?

A

Coeliac plexus nerve block

65
Q

What is the only treatment option that offers the possibility of long term remission for pancreatic cancer?

A

Surgery

66
Q

What surgical procedures can be used in pancreatic cancer?

A
  • Pancreaticoduodenectomy

- Total pancreatectomy

67
Q

What is the problem with the surgical procedures used in pancreatic cancer?

A

They are major procedures with high complication rates and serious morbidity

68
Q

What does surgical feasibility depend on in pancreatic cancer?

A
  • Tumour size
  • Tumour spread
  • Overall performance status of the patient
69
Q

What % of cases of pancreatic cancer reach the surgical feasibility criteria?

A

About 20%

70
Q

Is a cure common in surgical intervention in pancreatic cancer?

A

No, it is an outcome for a small minority

71
Q

What % of pancreatic cancer patients with radiologically operable tumours actually have surgically operable disease on laparotomy?

A

30%

72
Q

What surgical procedures might those with more advanced pancreatic cancer be suitable for?

A
  • Biliary stenting

- Bypass procedures

73
Q

What are the potential complications of surgery for pancreatic cancer?

A
  • Becoming diabetic

- Loosing pancreatic exocrine function

74
Q

How is the loss of pancreatic exocrine function following surgery managed?

A

By the use of pancreatic enzymes

75
Q

Who is radiotherapy most useful for in pancreatic cancer?

A

Those with locally advanced disease, for palliation of pain in particular

76
Q

What is the radiation dose in pancreatic cancer?

A

High, 40-60Gy

77
Q

What is the result of the radiation dose being high in pancreatic cancer?

A

Adverse effects may outweigh benefits

78
Q

What might chemotherapy be used for in pancreatic cancer?

A

Pallitation

79
Q

What chemotherapy agent is used in pancreatic cancer?

A

Gemcitabine

80
Q

What kind of chemotherapy agent is gemcitabine?

A

A nucleoside analogue

81
Q

What is the benefit of gemcitabine in pancreatic cancer?

A

It has been shown to improve symptoms and disease control

82
Q

When can chemotherapy be administered in pancreatic cancer?

A
  • Before or after surgery
  • In advanced disease
  • In combination with radiotherapy
83
Q

What chemotherapy combination is used in pancreatic cancer?

A

FOLFIRINOX (5-FU, folinic acid, irinotecan, and oxaliplatin)

84
Q

What is the advantage of FOLFIRINOX?

A

It has been shown in clinical trials to provide a better survival time in advanced pancreatic cancer than gemcitabine alone

85
Q

What is the disadvantage of FOLFIRINOX?

A

It is considerably more toxic than gemcitabine alone

86
Q

What affect have improvements in palliative care had on pancreatic cancer prognosis?

A

They have lead to a modest increase in short term survival of pancreatic cancer

87
Q

What is the median survival of patients with locally advanced or metastatic pancreatic cancer?

A

3-4 months

88
Q

What is the median survival for those who have had surgical resection of pancreatic cancer?

A

11-20 months

89
Q

What is the 1 year survival of pancreatic cancer?

A

16%

90
Q

What is the 5 year survival of pancreatic cancer?

A

About 3%

91
Q

Which pancreatic cancer patients have a better prognosis?

A

Those diagnosed early with periampullary cancer, with a 5 year survival of up to 50%

Z - Cancer Care Old (28 decks)

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