Pancreatic cancer (GI) Flashcards
What does pancreatic cancer refer to?
Primary pancreatic ductal adenocarcinoma - most common form which accounts for >90%
Which demographic is pancreatic cancer most common in?
65-75 years of old
Where are most pancreatic cancers found?
Most within head of pancreas > body > tail > multifocal
Where are pancreatic cancer distant metastases found? (4)
- liver
- lung
- skin
- brain
Describe the course of pancreatic cancer.
Linear progression model from pre-invasive pancreatic intraepithelial lesions to invasive ductal adenocarcinoma
Distinct precursor lesions are:
- pancreatic intraepithelial neoplasia (PanIN)
- intraductal papillary mucinous neoplasm
- mucinous cystic neoplasm
What are some risk factors for pancreatic cancer? (8)
- smoking
- high alcohol consumption
- family history
- chronic pancreatitis
- T2DM
- obesity
- diet - high in red meat / low folate
- inherited genetic syndromes:
- Peutz-Jeghers syndrome
- hereditary breast and ovarian cancer syndrome
- hereditary ovarian cancer syndrome
- Lynch syndrome
What is the most common presentation of pancreatic cancer?
65-75 years of age with painless obstructive jaundice and weight loss
Generally presents late with advanced disease
What are the clinical features of pancreatic cancer? (7)
- painless jaundice (due to biliary obstruction)
- non-specific upper abdominal pain or discomfort (–> back, worse when flat, RUQ if head of pancreas cancer)
- back pain (persistent = retroperitoneal metastases)
- weight loss and anorexia (advanced sign)
- steatorrhoea - greasy loose stools (extensive pancreatic infiltration/obstruction of major ducts –> exocrine dysfunction)
- pale stools (reduced stercobilinogen) + dark urine (reduced urobilinogen + increased conjugated BR) - cancer at head of pancreas obstructs bile flow
- pruritus (due to bile salts in circulation)
What might you find on examination in pancreatic cancer? (4+3)
- Courvoisier’s sign positive - painless palpable gallbladder and jaundice (more likely to be head of pancreas)
- Trousseau’s sign of malignancy - migratory thrombophlebitis due to increased risk of thromboembolic disease in pancreatic cancer
- signs of DIC - petechiae, purpura, bruising
- palpable abdominal masses:
- hepatomegaly - due to metastases
- gallbladder - Courvoisier’s law states that in the presence of painless obstructive jaundice, a palpable GB is unlikely to be due to gallstones
- epigastric mass - primary tumour
What is Courvoisier’s law in pancreatic cancer?
In the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones (most likely to be pancreatic cancer)
What is a sign of exocrine and endocrine dysfunction in pancreatic cancer?
- exocrine dysfunction - steatorrhoea
- endocrine dysfunction - new onset DM
What are the first-line investigations for pancreatic cancer? (3)
- pancreatic protocol CT
- abdominal ultrasound
- LFTs
What is the first-line investigation for pancreatic cancer?
High resolution pancreas-specific CT - to show mass in pancreas –> diagnose, stage and determine if treatable
What sign do we look for in CT pancreas in pancreatic cancer?
Double duct sign - dilatation of both pancreatic and common bile ducts
What investigation do we do in suspected pancreatic cancer if CT not available?
Abdominal ultrasound - detects pancreatic mass, dilated bile ducts and liver metastases
