Pancreatic carcinoma

Question 1

Where do 70% of cancers of the pancreas occur?

Answer 1

The head of the pancreas

Question 2

List some factors which have been associated with the development of pancreatic carcinoma?

Answer 2

Smoking
Chronic pancreatitis (which may be secondary to excessive alcohol consumption)
High fat diet
Diabetes mellitus
Occupational exposure to coal gas and aluminium

Question 3

What type of cancer makes up 75% of pancreatic cancers?

Answer 3

Adenomas

Question 4

Pancreatic cancers are rarely a result of endocrine neoplasias such as what?

Answer 4

Insulinoma

Glucagonoma

Question 5

What age group does pancreatic cancer normally affect?

Answer 5

The elderly

Rare in people under 50 years of age

Question 6

Are men or women more affected, and what is the ratio?

Answer 6

Men are more commonly affected, in the ration 3:2

Question 7

What is the 5 year survival of pancreatic cancer?

Answer 7

3%- worst of all cancers

Question 8

List some presenting features of pancreatic carcinoma?

Answer 8

Weight loss
Deep epigastric pain which radiates to the back in 60% of cases
Jaundice with pruritus if cancer affects head of pancreas (50% of cases)
Ascites with a knobbly liver
Anorexia, nausea and vomiting
Palpable gallbladder (coursoivier’s law)

Question 9

What is the curative treatment for pancreatic cancer?

Answer 9

Surgery- radical pancreaticoduodenectomy.

Whipple’s operation may be used

Question 10

What is the palliative management of pancreatic carcinoma?

Answer 10

Endoscopic or percutaneous stenting may relieve jaundice and associated itching
Surgical intervention- creation of biliary diversion via cholecystojejenostomy
Gastroenterostomy may be needed to manage vomiting
Pain relief- opiates and/or coeliac plexus block
Chemotherapy may be considered but is very toxic and has limited benefits