Pancreatic Carcinoma

Question 1

Outline the pathogenesis of pancreatic carcinoma. Where are the common metastases?

Answer 1

• Most involve a mutation in KRAS2
• Most involve the head of the pancreas and are commonly metastatic
  
  • Common sites include liver, lung, skin, brain

Question 2

What are the risk factors for pancreatic cancer?

Answer 2

• Cigarette smoking
• FHx
• Diabetes
• Chronic pancreatitis

Question 3

What are the common findings on history/exam in patients with pancreatic cancer?

Answer 3

• Risk factors
• Jaundice (painless)
• Upper abdo pain
• (Sometimes) new diabetes without FHx
• (Sometimes) acute pancreatitis
• (Sometimes) palpable gallbladder - Couvoisier’s rule

Question 4

What would be some sensible tests to run to confirm a diagnosis of pancreatic cancer?

Answer 4

• FBE
• LFTs
• US abdo
• CT

Question 5

What are the management principles for pancreatic cancer?

Answer 5

• Surgical intervention
  
  • Resection of cancer with neoadjuvant, adjuvant therapy
• Replacement of enzymatic function
  
  • Pancrelipase
• Palliation if unresectable/metastatic