Pancreatic Cancer

Question 1

Most common type

Answer 1

90% are adenocarcinomas of the head of the pancreas

Typically metastasize early to liver, then to peritoneum, lungs and bones
All cases must be discussed at HPB (hepatobiliary) MDT meeting to decide management
Peak incidence in 70s and 80s
5 year survival is 25% for early disease
Average survival for advanced disease is around 6 months

Question 2

Clinical Features

Answer 2

Present late as does not usually cause symptoms until blocking biliary system and causing PAINLESS JAUNDICE

• Non-specific upper abdominal/back pain
• Painless obstructive jaundice
• Unintentional weight loss
• Pale stools (due to lack of bile)
• Steatorrhoea (greasy stools due to malabsorption due to lack of bile)
• Dark urine (due to obstructive jaundice)
• Palpable mass in epigastric region

Question 3

Diagnosis

Answer 3

CA19-9 tumour marker (blood test)

CT scan (including thorax, abdomen and pelvis for staging)

Endoscopic ultrasound with biopsy

Question 4

Courvoisier’s law

Answer 4

Painless jaundice plus a non-tender palpable gallbladder is pancreatic cancer until proven otherwise

Question 5

Management

Answer 5

WHIPPLE’S PROCEDURE

• Requires the patient the be in good baseline health
• For tumour of head of pancreas with no spread
• Involves removing head of pancreas, gallbladder, duodenum and pylorus
• Modified Whipple’s involves leaving the pylorus, and has equal success rates to traditional Whipples

DISTAL PANCREATECTOMY
- for tumour of body/tail of pancreas

ADJUVANT CHEMOTHERAPY

Question 6

Late Disease Management

Answer 6

• Palliative chemotherapy may be offered if fit to attempt to extend life
• Palliative stenting of bile ducts to relive obstruction
• Palliative care