Pancreatic cancer

Question 1

What is pancreatic cancer?

Answer 1

Pancreatic cancer = malignancy arising from the exocrine or endocrine tissues of the pancreas

Refers for primary pancreatic ductal adenocarcinoma - >85% of all pancreatic neoplasms

Question 2

What is the aetiology of pancreatic cancer?

Answer 2

Unknown cause

Genetic factors have been identified - 5-10% have an inherited component: BRCA2 mutation, MEN, HNPCC etc

The only consistent environmental factor is cigarette smoking

Precursor lesions - Intraductal neoplasia, Intraductal mucinous neoplasm

Question 3

What are the risk factors of pancreatic cancer?

Answer 3

Smoking
FH
Hereditary cancer syndromes
DM

Question 4

What is the epidemiology of pancreatic cancer?

Answer 4

Poor prognosis - 5YS at 5%

Increasing incidence - Worldwide 8th cause of cancer death

2x more common in males

Peak age 60-80 y/o

Question 5

What are the symptoms of pancreatic cancer?

Answer 5

Constitutional + non-specific
FLAWS
Malaise
Nausea

Later symptoms
Jaundice
Epigastric pain

Question 6

What are the signs of pancreatic cancer?

Answer 6

Signs of weight loss

Epigastric tenderness/mass

Positive Courvoisier’s sign - Painless palpable gallbladder, Jaundice

Hepatomegaly (metastases)

Question 7

What are the appropriate investigation for pancreatic cancer?

Answer 7

Bloods
LFTs - If obstructive: Raised bilirubin, GGT and ALP

Tumour markers - CA19-9 elevated, CEA elevated

FBC - DIC: thrombocytopenia, GI bleed: anaemia
Prolonged PT

Imaging
Abdominal US - Pancreatic mass, Dilated bile ducts, Liver metastases

Endoscopic US

CT/MRI/PET

ERCP - Biopsy and stenting