Pancreatic Cancer

Question 1

Define Pancreatic Cancer?

Answer 1

Malignancy arising from the exocrine or endocrine tissues of the pancreas

Question 2

What percentage of pancreatic cancers are hereditary?

Answer 2

5-10%

Question 3

What causes these hereditary pancreatic cancers?

Answer 3

MEN
HNPCC
FAP
Von-Hippel Lindea Syndrome

Question 4

What are the risk factors for Pancreatic Cancer?

Answer 4

Age 
Smoking
Diabetes Mellitus 
Chronic Pancreatitis 
Dietary (low intake of fresh fruit and vegetables)

Question 5

What is the epidemiology of pancreatic cancer?

Answer 5

Increasing incidence
2x more common in MALES
Peak age: 60-80 years

Question 6

What are the presenting symptoms of pancreatic cancer?

Answer 6

Initial symptoms are often NON-SPECIFIC 
Anorexia
Malaise 
Nausea
Epigastric Pain
Weight Loss 
DM
Jaundice

Question 7

What are the signs of Pancreatic Cancer on physical examination?

Answer 7

Weight Loss
Epigastric tenderness or mass
Jaundice and a palpapble gallbladder (Courvoisier’s Law)
If metastatic spread then you would see hepatomegaly
Trousseau’s Sign of Malignancy

Question 8

What is Trousseu’s Sign of Malignancy?

Answer 8

Superficial Thrombophlebitis

Question 9

What bloods would you do for pancreatic cancer and what would you see?

Answer 9

CA 19-9
CEA is also elevated
Obstructive jaundice features

Question 10

What are Obstructive Jaundice features?

Answer 10

High Bilirubin
High ALP
Deranged clotting

Question 11

What are the imaging investigations you would do for Pancreatic Cancer?

Answer 11

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