Pancreatic Cancer

Question 1

Pancreatic cancer risk factors (SINED)

Answer 1

Smoking and alcohol 
Inflammation - Chronic pancreatitis 
Nutrition - Obesity
EtOH
DM

Question 2

Presentation

Answer 2

Often insidious until too late
60 + yo
Male

New onset diabetes - maybe unusual
Weight loss
Late jaundice
Post hepatic obstruction - pale floating stools, dark urine
Body/Tail - epigastric pain which radiates to back

Question 3

Courvoisier’s law

Answer 3

If painless jaundice with non tender palpable gall bladder -unlikely to be gallstones

Question 4

Signs on examination

Answer 4

Metastases can cause:

• hepatomegaly
• splenomegaly
• lymphadenopathy
• ascites

Question 5

Rare associated presentations

Answer 5

Thrombophlebitis migrans
Hypercalcaemia
Portal hypertension
Nephrotic syndrome

Question 6

Investigations

Answer 6

Bloods - LFTS, U+Es, FBC
Special bloods - CA 19-9 (not diagnostic)
Abdominal USS - biliary tree dilation and identify mass
Pancreatic protocol CT
ERCP/MRCP - biliary tree anatomy, biopsy, bile cytology or stenting

Question 7

Management

Answer 7

Surgical resection

• whipple’s procedure
• transverso - longmire

Chemotherapy
Radiotherapy
Pancreatic enzyme supplements
Palliative care

Question 8

Pathology

Answer 8

Mostly ductal adenocarcinoma

• Metastasis early, present late

Question 9

Indications for surgery

Answer 9

Fit, no mets, tumour ≤3cm