pancreatic cancer Flashcards
median age of diagnosis
70
who gets it more male or female
male
what are the majority of cancers
adenocarcinoma
whee are majority origin
ductal origin
what increases incidence
- smoking
- alcohol
- coffee
- aspirin use
- diabetes
what mutation in chronic pancreatitis increases risk
PRSS-1
what type of gene is BRCA2
DNA repair gene
where does the cancer originate
in the ductal epithelium
what are the precursors of malignancy
pancreatic intraepithelial neoplasia (PainIN)
what mutation does majority of patients have
KRAS
if there is a mutation in tumour suppressors (p53, SMAD) what type of neoplasia does it cause
type 2
and
type 3 lesions
what is the genetic model for development of pancreatic malignancy
- normal
- PanIN-1A
- PanIN-1B
- PanIN-2
- PanIN-3
- invasion
where do a small percentage of pancreatic adenocarcinomas arise from
cystic lesions
where are most pancreatic cancers located
in head of pancreas
symptoms
- abdominal pain radiates through to back
- anorexia
- weight loss
- depressive
- jaundice (early)
- pale stools
- dark urine
- itching
- malabsorption
- steatorrhoea
- skin nodules
what does malabsorption mean
the pancreatic duct is obstructed by cancer
signs
- palpable gallbladder
- palpable epigastric mass
- hepatomegaly (if liver metastases)
investigations if patients has upper gut symptoms
upper GI endoscopy
what is the initial imaging investigation
ultrasound
what is seen on ultrasound of bile obstruction
dilated intrahepatic bile ducts
and
mass in the head of the pancreas
what investigation can confirm the presence of a mass lesion
CT
what is the most sensitive for detection of pancreatic cancer
endoscopic ultrasound
what tumour markers are good
CA19-9
what is the only treatment for long term survival
surgical intervention
what surgery is required to remove tumours of head and neck of pancreas
Whipple procedure
how are tumours of the body and tail resected
distal pancreatectomy
how to treat the pain
opiates
treatment for nutritional deficit
- early dietetic support
- pancreatic enzyme supplement
what does jaundice usually occur with
anorexia and nausea and pruritus
how to treat jaundice
endoscopic placement of endoprostheses (stent)
what are most lesions
pseudocysts
what imaging is used for characterising lesions
CT and MRI
are lesions at risk of becoming malignant
yes
where do pancreatic neuroendocrine tumours (NETs) arise from
islets of Langerhans
what do NETs synthesise
insulin and glucagon
what are majority of endocrine neoplasia
malignant
symptoms of VIPoma
- water diarrhoea
- hypokalaemia
- metabolic acidosis
what are glucagonomas
alpha-cell tumours
how are glucagonomas diagnosed
measuring pancreatic glucagon in the serum
what are somatostatinomas
rare malignant D-cell tumours of the pancreas
how are somatostatinomas diagnosed
high serum somatostatin levels
examples of somatostain analogues
ocreotide and lanreotide
