Pancreatic Cancer

Question 1

Symptoms / presentation of pancreatic cancer

Answer 1

non specific upper abdominal pain / back pain

painless obstructive jaundice (the cancer is blocking the biliary system so bile)

unintentional weight loss
pale stools (lack of bile)
steatorrhoea (greasy stools- malabsorption again due to lack of bile)
dark urine (obstructive jaundice)
palpable mass in epigastric region

*painless jaundice plus a non tender palpable gallbladder is pancreatic cancer until proven otherwise (courvoisier’s law)

Question 2

how is pancreatic cancer diagnosed?

investigations

Answer 2

bloods: Ca19-9 tumor marker
CT scan (TAP)
endoscopic US with biopsy

Question 3

Whipple procedure

Answer 3

pt needs good baseline health
indicated in tumor of head of pancreas with no spread
remove head of pancreas, gallbladder, duodenum, pylorus

distal pancrectomy for tumor of body/tail of pancreas
adjuvant chemotherapy

Palliative chemotherapy may be offered if fit to attempt to extend life
Palliative stenting of bile ducts to relive obstruction
Palliative care