Pancreatic cancer Flashcards
What sex does pancreatic carcinoma occur more commonly in?
Male
What age range does pancreatic cancer most commonly occur in?
60-80 years old
What are risk factors for developing pancreatic cancer?
- Smoking
- Alcohol
- Carcinogens
- Diabetes mellitus
- Chronic pncreatitis
- Increased waist circumference
- High fat/red/processed meat diet
What type of carcinoma is most common in the pancreas?
Adenocarcinoma arising from ductal epithelial cells
Describe the pathogenesis of pancreatic cancer?
Cancer originates in the ductal epithelium and evolves from premalignant lesions to fully invasive cancer. The lesion called pancreatic intraepithelial neoplasia (PanIN) is the best-characterized histologic precursor of pancreatic cancer.
There is progression from minimally dysplastic epithelium (PanIN grades 1A and 1B) to more severe dysplasia (grades 2 and 3)
What proportion of pancreatic cancers arise in the head of the pancreas?
75%
What are the main types of pancreatic cancer?
- Adenocarcinoma
- Carcinosarcoma
- Cystadenocarcinoma
- Acinar cell carcinoma
What proportion of pancreatic cancers arise from the body of the pancreas?
25%
What genetic mutation is very commonly found in people with pancreatic cancer?
KRAS2
What are symptoms of cancer in the head of the pancreas?
- Painless obstructive jaundice
- Sympatomatic episodes of pancreatitis
- Symptoms of diabetes - polyuria, polydipsia, thirst
- Itching
What symptoms might you find in pancreatic cancers of the pancreatic body or tail?
- Upper abdominal pain - can radiate tot he back, partial relief sitting forward
- Weight loss/anorexia
- Fatigue
- Diarrhoea/Steatorrhoea
- Nausea/vomiting
What are general signs that someone might have pancreatic cancer?
- Jaundice + painless palpable gall bladder (Courvoisier’s sign)
- Epigastric mass
- Hepatomegaly
- Splenomegaly
- Lymphadenopathy
- Ascites
What is courvoisier’s sign?
In a jaundiced patient, the combination of a non-tender, distended gallbladder and obstructive jaundice is taken to indicate a non-calculous obstruction of the common bile duct.
It is commonly said to be a sign of obstruction to the biliary system by malignancy
What conditions is courvoisier’s sign most commonly seen in?
- Cholangiosarcoma
- Cancer of the head of the pancreas
- Cholelithiasis – uncommon
Why does courvoisiers sign happen?
Thought to be that chronic obstruction of the biliary system and/or gallbladder leads to higher biliary duct pressure over a long period of time and does not provide the acute distension that usually causes inflammation and pain. Malignant causes of obstruction are more likely to provide chronic distension.
What are rare features that can manifest in pancreatic cancer?
- Thrombophlebitis migrans
- Maranatic endocarditis
- Portal hypertension
- Nephrosis
- Hypercalcaemia
If you suspected pancreatic carcinoma, what investigations would you consider doing?
- Bloods - CA 19-9, LFTs
- CXR
- Abdominal US -> CT Scan +/- EUS to confirm
- Percutaneous needle biopsy
- CT/PET for staging
If someone had features of pancreatic cancer and pulmonary symptoms, what might this indicate in terms of severity of disease?
Advanced disease
Which part of the pancreas would you be thinking is affected by cancer if courvoisiers sign was present?
Head of the pancreas - also present with itch due to cholestasis
What tumour marker can be used to diagnose and monitor pancreatic cancer?
CA19-9
How would you manage pancreatic cancer?
Most ductal tumours present with metastatic disease
-
Radical surgery- pancreatoduodenectomy (Whipple’s procedure)
- Patient is fit, Tumour <3 cm diameter, No metastases
-
Palliation of jaundice
- Stent
- Palliative surgery - cholechoduodenostomy
- Pain control - opiates, coeliac plexus block, radiotherapy
What methods are used for pain control in pancreatic cancer?
- Opiates
- Coeliac plexus block
- Radiotherapy
What palliative interventions are used in pancreatic cancer?
- Endoscopic/percutaneous stent
- Bypass surgery - cholechoduodenostomy
What is the mean survival for those with pancreatic cancer?
Mean survival < 6 months
What is whipple’s procedure?
A complex operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct. The Whipple procedure is used to treat tumors and other disorders of the pancreas, intestine and bile duct
What surgical procedures are used to resect cancers in the tail of the pancreas?
- Distal Pancreatectomy
- Total Pancreatectomy (Whipple’s)
What procedures can be used to relieve jaundice in someone with inoperable pancreatic cancer?
Internal biliary stent placed by ERCP/PTC
What surgical procedures can be used to treat gastric outlet obstruction in inoperable cases of pancreatic cancer?
- Duodenal stent
- Laparoscopic Gastrojejunostomy
