Pancreatic Cancer

Question 1

What is Pancreatic Cancer?

Answer 1

Malignancy arising from exocrine (more common) or endocrine tissues of the pancreas

Question 2

Describe the aetiology of pancreatic cancer

Answer 2

UNKNOWN
5-10% hereditary (e.g. MEN, HNPCC, FAP, Von-Hippel Lindau syndrome)
75% occur within head or neck of pancreas.
15-20% occur in body
5-10% in tail

Question 3

List 8 risk factors for pancreatic cancer

Answer 3

Age  
Smoking 
FH 
Alcohol  
Diabetes mellitus  
Chronic pancreatitis  
Dietary (low fruit + vegetables, high fat + red/ processed meat)  
High waist circumference

Question 4

What is the most common type of pancreatic cancer?

Answer 4

Ductal adenocarcinoma

Question 5

Why does pancreatic cancer usually have a poor prognosis?

Answer 5

Presents very late

Question 6

Describe the epidemiology of pancreatic cancer

Answer 6

Increasing incidence: 8-12/100,000
M > F
Peak age: 60-80 yrs

Question 7

List 6 symptoms of pancreatic cancer

Answer 7

Initial Sx are often NON-SPECIFIC 
Anorexia 
Malaise  
Nausea
Epigastric pain
DM Sx like thirst, poluria + nocturia

Question 8

List 6 signs of pancreatic cancer

Answer 8

Weight loss
Jaundice
Epigastric tenderness or mass (late stages)
Palpable gallbladder
If mets: hepatomegaly/ splenomegaly/ lymphadenopathy
Signs of DIC in advanced disease (petechiae, purpura, bruising)

Question 9

What is Courvoisiers law?

Answer 9

A palpable gallbladder with painless jaundice is unlikely to be due to gallstones

Question 10

What is Trousseau’s sign of malignancy?

Answer 10

Superficial thrombophlebitis

Question 11

What are the first line investigations in suspected pancreatic cancer?

Answer 11

Pancreatic protocol CT
+ LFTs
+/- Abdo USS

Question 12

What can pancreatic cancer cause? Thus what bloods may be seen in pancreatic cancer?

Answer 12

Obstructive jaundice
High bilirubin  
High ALP 
High GGT 
Deranged clotting

Question 13

What may be seen on US in pancreatic cancer?

Answer 13

Pancreatic mass
Dilated bile ducts
Liver metastases

Question 14

What tumour markers are associated with pancreatic cancer?

Answer 14

CA 19-9 (more specific)
CEA
Both will be elevated, but neither are diagnostic

Question 15

What other investigations may be performed in pancreatic cancer?

Answer 15

Prolonged PT: Plts decrease in DIC + anaemia in GI bleeding
PET if CT is unclear
ERCP: ampullary tumour may be seen + other tumours only detectable if there is pancreatic duct involvement

Question 16

What procedure can be performed if the pancreatic tumour is small with no metastases?

Answer 16

Whipple’s procedure

Question 17

What is rarely helpful in pancreatic cancer?

Answer 17

Chemotherapy

Radiotherapy