Pancreatic Cancer Flashcards
What is the epidemiology of pancreatic cancer
- 3% of all malignancy
- ~9000 deaths/yr in UK
- UK incidence rising
What are the risk factors of pancreatic cancer
- male over 70 = typical patient
- smoking
- alcohol
- carcinogens
- diabetes
- chronic pancreatitis
- increase in weight circumference
- diet high in fats and red/processed meats
Where is the pancreatic cancer most likely to be in the pancreas
- most likely ductal adenocarcinoma (metastasise early and present late)
- 60% in pancreas head
- 25% in pancreases body
- 15% in pancreas tail
- few in ampulla of Vater or pancreatic islet cells (insulinoma, gastronome, glucagonomas, somatostatinomas)
What gene is associated with pancreatic cancer
95% have mutations in KRAS2 gene
How does pancreatic cancer present in the head of the pancreas
- painless obstructive jaundice
How does pancreatic cancer present if it is in the body and tail of pancreas tumours
- epigastric pain (radiating to back and relieved by sitting forwards) in 75%
What are other symptoms of pancreatic cancer
- anorexia
- weight loss
- diabetes
- acute pancreatitis
What are rare features of pancreatic cancer
- Thrombophlebitis migrans (eg an arm vein becomes swollen and red, then a leg vein)
- ↑Ca2+
- Marantic endocarditis
- Portal hypertension (splenic vein thrombosis)
- Nephrosis (renal vein metastases)
What are the signs of pancreatic cancer
- Courvoisier’s law: Jaundice and palpable gallbladder
- epigastric mass
- hepatomegaly
- splenomegaly
- lymphadenopathy
- ascites
What does blood show in pancreatic cancer
- cholestatic jaundice
- increase in CA-19-9 - non specific but helps assess prognosis
What does imaging show in pancreatic cancer
US/CT
- can show pancreatic mass, dilated biliary tree and hepatic metastases
- guide biopsy and help staging prior to surgery/stent insertion
MRCP/ERCP
- shows biliary tree anatomy and localise the site of obstruction
EUS
- emerging adjunct for diagnosis and staging
What is the treatment for pancreatic cancer
Surgery
What type of surgery is used for pancreatic cancer
- Pancreatoduodenectomy (Whipple’s)
- laparoscopic excision
When is a Whipple’s surgery considered
- best considered only where no distant metastases and where vascular invasion is still at a minimum
What is laparoscopic excision considered for pancreatic cancer
- tail lesions are easiest removed here
