Pancreatic Carcinoma Flashcards
Describe morphology and prognosis of pancreatic carcinoma?
90% of pancreatic carcinomas are ductal adenocarcinomas arising from the ductal epithelium. 5% neuroendocrine.
60% are in the head of the pancreas.
The prognosis is very poor, 5 year survival rate is less than 5%
Ampullary and islet cell tumours have a better prognosis as present earlier
Describe the physical signs and symptoms depending on the location of the cancer?
Head of the pancreas: Painless obstructive jaundice (dark urine, pale stools) Weight loss Courvoiser's sign Hepatosplenomegaly or ascites
Body and the tail:
Back pain or epigastric pain
Weight Loss, fatigue
Either:
DM, trousseaus sign, steatorrhoea
May present with pancreatitis, or symptoms of metastases.
In late disease compression of the duodenum or the stomach may cause gastric outlet obstruction or delayed gastric emptying, leading to nausea and vomiting.
Describe the investigations of suspected pancreatic Ca?
Baseline bloods. FBC, U+E, LFT
- Ca19.9 and CEA used as baseline
If suspected CT is needed.
Staging CT scan + PET scan.
Endoscopic USS/ ERCP can be used for biopsy
Describe the non-surgical management of pancreatic cancer?
Stenting of the bile duct or duodenum can be used to relieve obstruction caused by pancreatic cancer and sometimes surgical bypass is needed.
Other treatment options include palliative chemotherapy and radiotherapy.
However, pancreatic has a poor response to chemotherapy and radiotherapy so many patients prefer a purely palliative approach.
What is the surgical management of pancreatic Ca and which patients may this benefit?
Whipple’s procedure or modified Whipple’s procedure.
Only suitable in patients with head of the pancreas carcinoma and the decision to operate is based on the proximity of the Ca to major blood vessels (SMA and portal vein). Tumour <3cm and no mets.
Risk factors for pancreatic cancer
Smoking, alcohol, DM, chronic pancreatitis
Name some of the neuroendocrine tumours than can arise from pancreatitis and the effect they have on the body.
Insulinoma (causes low glucose) Glucagonoma (causes DM) Gastrinoma (Zollinger-ellison syndrome) Somatostatinoma (DM, gallstones, achlorrhydria) VIPoma (diarrhoea)
