Pancreatic Cancer

Question 1

Define pancreatic cancer

Answer 1

Malignancy arising from the exocrine and endocrine tissues of the pancreas
Precursors: intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm
(MCN)

Question 2

What are the causes/risk factors for pancreatic cancer?

Answer 2

80% are adenocarcinomas
• Smoking
• Hereditary pancreatitis
• Peutz-Jeghers syndrome
• Familial atypical multiple mole melanoma
• HNPCC syndrome
• BRCA2
• MEN (twice as common)

Question 3

Where do pancreatic cancers arise?

Answer 3

75% arise in the head/neck of the pancreas
15% in the body
10% in the tail

Question 4

What are the symptoms of pancreatic cancer?

Answer 4

• Anorexia
• Malaise
• Weight loss
• Nausea
• Painless jaundice
• Epigastric pain/discomfort
• Loss of endocrine – diabetes mellitus (polyuria, polydipsia, nocturia)
• Loss of exocrine function – steatorrhea

Question 5

What are the signs of pancreatic cancer?

Answer 5

Jaundice
• Palpable gallbladder (Courvoisier’s law – palpable gallbladder + painless jaundice is unlikely to be caused by gallstones)
• Hepatomegaly – hepatic metastases
• Trousseau’s sign – superficial thrombophlebitis (↑ risk of VTE in pancreatic ca)

Question 6

What investigations are carried out for pancreatic cancer?

Answer 6

**CA19-9 and CEA - elevated
• FBC - platelets decreased in DIC; Anaemia in GI bleeding
• LFTs - demonstrates the degree of obstructive jaundice, but cannot distinguish between any cause of obstructive jaundice or liver metastases.
• Clotting Screen - these may be prolonged due to vitamin K deficiency as a result of obstruction.
• USS Abdomen -pancreatic mass, dilated bile ducts, liver metastases
• Endoscopic USS ± Biopsy - pancreatic mass, dilated bile ducts, liver metastases, biopsy confirms pathological diagnosis
• CT/MRI/PET/ Laparoscopy - useful for staging the disease.
• ERCP/MRCP - ampullary tumour may be seen. All other pancreatic tumours are only detectable if there is pancreatic duct involvement