Pancreatic cancer (brief) Flashcards
How common is it?
4th commonest solid organ cancer. Incidence ↑ rapidly.
Who does it affect?
80% of cases occur between the 6th and 7th decade.
90% ductal adenocarcinoma.
7% mucinous cystic neoplasms.
3% islet cell tumours.
What risk factors are there?
Cigarette smoking
↑ age
high fat diet
diabetes
alcoholism and chronic pancreatitis.
Exposure to naphthalene and benzidine
Hereditary factors may be involved, 1/20 have a FH
How does it present?
Carcinoma of the head of the pancreas (65%):
- Obstructive jaundice. Gallbladder is typically palpable
- Pain 70%: epigastric or left upper quadrant, often vague and radiates to the back
- Hepatomegaly due to mets
- Anorexia, nausea and vomiting, fatigue, malaise, dyspepsia and pruritus
- As acute pancreatitis
- Thrombophlebitis migrans (10%) presents as emboli. Splenic vein thrombosis may lead to splenomegaly in 10% of patients.
Carcinoma of the body (25%) and tail (10%)
- Usually asymptomatic in the early stages
- Weight loss and back pain (60%)
- Epigastric mass
- Jaundice suggests spread to hilar lymph nodes or mets
- Thrombophlebitis migrans (7%)
- Diabetes mellitus (15%)
Investigations
FBC, LFTs, blood sugar
Elevated serum CA 19-9: sensitivity 90%; specificity 70% for diagnosis. Level correlates with tumour volume
Transabdominal US, 70% sensitivity in lesion greater than 2cm
Doppler US of portal vein
Helical CT scan of pancreas
FNA
ERCP (Endoscopic Retrograde Cholangiopancreatography)
Treatment
95% are not suitable for surgical resection. Relieve jaundice via ERCP. Relief of duodenal obstruction (surgical gastric bypass). Relief of pain (morphine). Adjuvant chemo and resection can improve prognosis where applicable. But even in resectable disease, 5-year survival is 12%.
Conditions that would present similarly
Acute Pancreatitis
Cholangitis
Cholecystitis
Choledochal Cysts
Chronic Pancreatitis
Gallstones (Cholelithiasis)
Gastric Cancer
Peptic Ulcer Disease
