Pancreatic cancer

Question 1

Define:

Answer 1

Malignancy arising from the exocrine or endocrine tissues of the pancreas

Question 2

Aetiology:

Answer 2

Unknown

5-10% are hereditary (MEN,FAP, HNPCC and Von-Hippel syndrome)

Poor prognosis as it presents very late

75% are at the head or neck of the pancreas

15-20% at the body

5-10% in the tail

Question 3

Risk factors:

Answer 3

Alcohol

Smoking

Chronic pancreatitis

Diabetes Mellitus

Dietary (low in fruit and veg)

Age

Question 4

Epidemiology:

Answer 4

8-12/100,000

2x more common in men

peak age of presentation 60-80 years

Question 5

Symptoms:

Answer 5

Non-specific:

• anorexia
• nausea
• malaise
• epigastric pain radiating to the back that is made better on sitting forward
• weight loss
• new onset diabetes mellitus in the elderly
• Jaundice

Question 6

Signs:

Answer 6

Epigastric mass or tenderness
Jaundice
palpable gallbladder with no pain (unlikely to be gall stones)
Weight loss
Trousseu’s sign of malignancy - superficial thrombophlebitis

If there is metastases:

• Lymphadenopathy
• Hepatomegaly
• Spelnomegaly

Question 7

Investigations:

Answer 7

1st line - LFT’s and abdo USS

Bloods - CEA + CA 19-9 (more specific) tumour markers

Obstructive jaundice - increased bilirubin and ALP as well as deranged clotting time

Imaging: to show pancreatic mass, bile duct dilation or hepatic masses
CT with/without biopsy
MRI/MRCP
ERCP - biopsy, stenting and bile cytology
US