Pancreatic Cancer

Question 1

Definition

Answer 1

Malignancy arising from the exocrine or endocrine tissues of the pancreas

Question 2

Aetiology

Answer 2

· UNKNOWN

· 5-10% are hereditary (e.g. MEN, HNPCC, FAP, Von-Hippel Lindau syndrome)

Question 3

Risk factors

Answer 3

o Age
o Smoking
o Diabetes mellitus
o Chronic pancreatitis
o Dietary (low intake of fresh fruit and vegetables)

Question 4

Epidemiology

Answer 4

· Increasing incidence

· 2 x more common in MALES

· Peak age: 60-80 yrs

Question 5

Presenting symptoms

Answer 5

· Initial symptoms are often NON-SPECIFIC
· Anorexia
· Malaise
· Nausea
· Epigastric pain
· Weight loss
· Diabetes mellitus
· Jaundice

Question 6

Signs on physical examination

Answer 6

· Weight loss

· Epigastric tenderness or mass

· Jaundice and a palpable gallbladder (Courvoisier’s law - a palpable gallbladder with painless jaundice is unlikely to be due to gallstones)

· If metastatic spread –> hepatomegaly

· Trousseau’s Sign of Malignancy - superficial thrombophlebitis (positive sign is a carpopedal spasm caused by inflating the bp cuff above systolic bp for 3mins)

Question 7

Investigations

Answer 7

· Bloods
o CA 19-9
o CEA is also elevated
o Obstructive jaundice features:
· High bilirubin
· High ALP
· Deranged clotting

· Imaging
o Ultrasound
o CT with/without guided biopsy
o MRI/MRCP
o ERCP - may allow biopsy, bile cytology and stenting