Pancreatic cancer Flashcards
How does cancer of head of pancreas typically present?
Presents earlier with painless jaundice (obstructive), but pain may develop as the disease progresses.
On examination there will be signs related to obstructive jaundice, Courvoisier’s sign in some cases or a palpable abdominal mass. Hepatosplenomegaly or ascites are also common.
How does cancer of tail of pancreas typically present?
More likely to present late with dull abdominal pain radiating through to the back, partially relieved on sitting forwards.
Non specific B symptoms common, often no physical signs on examination.
How would you investigate pancreatic cancer?
Bloods: LFT, FBC, U&E, CA or CEA are useful as baseline.
Amylase actually rarely elevated
Uss would confirm obstruction and duct dilatation
CT: pancreatic mass +/- dilated biliary tree +/- hepatic MET
Endoscopic USS +/- biopsy
Staging laproscopy?
What are the majority of pancreatic cancers?
Ductal adenocarcinoma
mostly in head, followed by body and then tail
Less than 2% are islet cell tumours
lnsulinoma;
o Symptomatic hypoglycaemic events (often in the mornings or on
exertion), as well as gross weight gain. 90% are benign. Glucagonoma;
o Often asymptomatic, secondary diabetes may develop. Gastrinoma;
o Zollinger-Ellison syndrome, with oesophagitis, GI ulcers and diarrhoea. Somatostatinoma;
o Present with diabetes (insulin release inhibited), achlorrhydria (gastrin release inhibited) and gallstones (CCK release inhibited).
VIPoma;
o Vasoactive intestinal peptide release causes profound diarrhoea.
Prognosis of pancreatic cancer
Mean survival <6months.
5 year survival <2%, rising to 5-15% following Whipple’s procedure. Ampullary and Islet cell tumours carry a better prognosis, as they often present relatively early.
Symptoms of pancreatic cancer
Jaundice Upper abdo pain Weight loss Altered bowel Steatorrhea Thromboembolism Recent onset diabetes
