Pancreatic Cancer

Question 1

What is the incidence?

Answer 1

Incidence: 11/100000 pop/year (increasing)

Question 2

What is the most common age group and gender?

Answer 2

80% in 60-80 year age group
Males>Females
More common in Western Countries: highest rates in Maoris & Hawaiians

Question 3

Where does the cancer arise in the pancreas?

Answer 3

75% are duct cell mutinous adenocarcinoma: head (60%), body (13%), tail (5%), multiple sites (22%)
Other pathological types: carcinosarcoma, cystadenocarcinoma (better prognosis), acinar cell

Question 4

What are the risk factors?

Answer 4

• Smoking
• Alcohol
• Diabetes mellitus
• Chronic pancreatitis
• Hereditary pancreatitis

Question 5

What are the 3 main clinical features?

Answer 5

Upper abdominal pain (75%): cancer body and tail
Painless obstructive jaundice (25%): cancer head
Weight loss (90%)

Question 6

What are the other clinical features?

Answer 6

Anorexia, fatigue, diarrhoea/steatorrhoea, nausea, vomiting
Tender subcutaneous fat nodules (like erythema nodosum) due to metastatic fat necrosis
Thrombophlebitis migrans
Ascites, portal hypertension

Question 7

What are the physical signs?

Answer 7

Hepatomegaly
Jaundice
Abdominal mass
Abdominal tenderness
Ascites, splenomegaly
Supraclavicular lymphadenopathy
PRESENCE OF ABOVE SIGNS USUALLY INDICATES AN UNRESECTABLE TUMOUR
Palpable gallbladder (with ampullary carcinoma)