Pancreatic Cancer Flashcards

1
Q

Most common pancreatic cancer

A

Ductal carcinoma of the pancreas (90%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What can the remaining cancers be divided into?

A

Exocrine tumours (pancreatic cystic carcinoma)

Endocrine tumours (from islet cells of pancreas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Epidemiology

A

High mortality

Rare under 40 years of age

80% of cases occur between 60-80yrs

Rarely diagnosed early enough for curative treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pathophysiology of ductal carcinoma

A

Direct invasion of local structures which involves the spleen ,transverse colon and adrenal glands

There is also lympathic metastasis in regional LN, liver, lungs and peritoneum

Metastasis is common at time of diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Risk factors

A

Smoking and chronic pancreatitis

Hereditary

Late onset DM (>50 years of age onset have 8x greater risk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Specific clinical features

A

Obstructive jaundice that is painless

Weight loss due to metabolic effects or secondary to exocrine dysfunction

Abdo pain due to invasion of coeliac plexus or pancreatitis

Can also have presentation of acute pancreatitis or thrombophlebitis migrans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Examination findings

A

Cachexia

Malnourished

Jaundic

Abdo mass

Enlarged gallbladder as per Courvoisier’s law

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Courvoisier’s law?

A

Presence of jaundice and an enlarged/palpable gallbladder should warrant suspicion of malignancy of the biliary tree or pancreas.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dx

A

Causes of obstructive jaundice

Causes of epigastric abdo pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lab tests

A

Routine bloods with FBC, LFTs etc…

Serum amylase and clotting would be done as well

CA19-9 tumour marker as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lab test findings

A

Anaemia or thrombocytopenia

Raised bilirubin, ALP and GGT

CA19-9 is raised but better in assessing response to treatment rather than for intial diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Initial imaging

A

Abdo USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Other imaging

A

CT imaging

CT chest,abdo,pelvis

PET CT

EUS with fine needle aspiration biopsy

ERCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

USS findings

A

Pancreatic mass or a dilated biliary tree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the most important investiation in terms of diagnosis

A

CT imaging

It is also the most prognostically informative imaging modality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What should be done after confirming diagnosis with CT?

A

CT abdo-pelvis-chest to check staging

PET-CT may be warranted as well.

EUS fine needle aspiration biopsy might be done if diagnosis is still unclear.

ERCP can be used to access the lesion for biopsy or cytology

17
Q

What is the only curative management option of pancreatic cancer?

A

Radical resection

18
Q

Approach for tumours of the head of the pancreas

A

Pancreaticduodenectomy (Whipple’s procedure)

19
Q

Approach for patients with tumours of the body or tail of pancreas

A

Distal pancreatectomy

20
Q

Absolute contraindications to surgery

A

Peritoneal, liver and distant metastases

21
Q

Complications of radical resection

A

Pancreatic fistula

Delayed gastric emptying

Pancreatic insufficiency

22
Q

Explain Whipple’s procedure

A

Removal of the head of the pancreas, the antrum of the stomach and the 1st and 2nd parts of the duodenum.

Also removal of the common bile duct and the gallbladder.

Tail of the pancreas and the hepatic duct are attached to the jejunum to allow bile and pancreatic juice to drain into the gut.

Stomach is the anastomosed with jejunum allowing for passage of food.

23
Q

Why are all of those viscera removed?

A

Because they share a common arterial supply of the gastroduodenal artery with the head of the pancreas and the duodenum.

24
Q

When is chemo used?

A

Adjuvant chemotherapy with 5-fluorouracil is recommended after surgery.

In metastatic disease FOLFIRINOX regime can be used in patients with good performance status

25
Q

Palliative care of pancreatic cancer

A

Insertion of biliary stent via ERCP or percutaneously

Palliative chemotherapy that is gemcitabine-based

Exocrine insufficiency is common in advanced disease so enzyme replacement might be used.

26
Q

Prognosis

A

5 year <5%

27
Q
A