Pancreatic Cancer

Question 1

What age group is pancreatic cancer most common?

Answer 1

60-80 years.

Question 2

What are the risk factors for pancreatic cancer?

Answer 2

Smoking, age, high fat diet, diabetes mellitus, alcoholism, chronic pancreatitis.

Question 3

What percentage of pancreatic cancers are ductal adenocarcinomas?

Answer 3

90%.

Question 4

What percentage of pancreatic cancers are islet cell tumours?

Answer 4

3%.

Question 5

How does a head of the pancreas carcinoma present?

Answer 5

Presents with obstructive jaundice, usually palpable gall bladder, often vague epigastric pain, hepatomegaly if metastases, anorexia, N&V, weight loss, fatigue, malaise.
TROUSSEAU’S SIGN OF MALIGNANCY (thrombophlebitis migrans) can occur in 10% of cases.

Question 6

How does a body or tail carcinoma of the pancreas present?

Answer 6

Asymptomatic early on, weight loss and back pain, epigastric pain, thrombophlebitis migrans.

Question 7

What investigations should be performed if pancreatic cancer is suspected?

Answer 7

Blood test - elevated Ca19-9.

USS, CT with contrast, PET scans can all be used to stage the tumour.

Question 8

Why may pancreatic cancer not be suitable for surgical resection?

Answer 8

Not suitable for surgical resection due to invasion, metastases, lymph node involvement, age or comorbidities.

Question 9

What is the palliative management of pancreatic cancer?

Answer 9

Relief of jaundice by ERCP, pain relief (morphine or chemical ablation of coeliac ganglia).

Question 10

What does curative resection of a pancreatic carcinoma involve?

Answer 10

PANCREATODUODENECTOMY (Whipple’s procedure) for preambulary and head of pancreas tumours or TOTAL PANCREATECTOMY for extensive tumours.
Adjuvant chemo with 5-FU improves prognosis.