Pancreatic Carcinoma

Question 1

Demographic

Answer 1

Male

Over 70

Question 2

Risk factors causes

Answer 2

Smoking
Alcohol
Obesity esp inc weight circumference 
Inc fat diet 
Inc processed meat diet

Question 3

Pathology

Answer 3

Ductal adenocarcinoma
- met early
- present late
60% head, 25% body, 15% tail

Rarer but have a better prognosis
Ampullary tumours
Pancreatic islet cell tumours - insulinoma, glucagonoma, gastronoma, somatostatinoma, VIPoma

Question 4

Genetics 🧬

Answer 4

Approx 95% have a mutation in KRAS2 gene

Question 5

Presentation

Answer 5

Head of pancreas 
- painless obstructive jaundice 
95% of body and tail
- epigastric pain relieved by sitting forward 
Anorexia 
Weightloss 
Jaundice
Diabetes
Acute pancreatitis 
Rare
Thrombophlebitis migrans 
Inc ca2+ 
Marantic endocarditis 
Portal hypertension 
Splenic vein thrombosis 
Nephrosis

Question 6

Signs

Answer 6

Jaundice + palpable gall bladder 
Courvoisiers law
Epigastric mass
Hepatomegaly
Splenomegaly 
Lymphadenopathy 
Ascites

Question 7

Tumour marked

Answer 7

CA19-9

Non specific but can help assess prognosis

Question 8

Tests

Answer 8

Blood - cholestatic jaundice
US CT mass +- dilated biliary tree +- hepatic mets guide biopsy and staging
ERCP/MRCP any biliary obstruction
EUS adjunct to staging

Question 9

Treatment

Answer 9

Conservative - palliative team essential
Medical -
Pain
Opiates
Radiotherapy
Coeliac plexus infiltration with alcohol at time of surgery or percutaneously
Jaundice - endoscopic percutanous stent insertion
Chemo can delay disease progression
Surgery
Rare - palliative bypass surgery for duodenal la obstruction or unsuccessful ERCP
Laparoscopic - tail surgery
Pancreaticoduodenctomy - whipples need no mets and minimally invasion into vasculature

Question 10

Prognosis

Answer 10

<6months 
3% 5 year survival 
Whipples 5-14% 5 year survival 
Better prognosis tumour <3cm , no nodes or mets, -ve resection margin 
Ampullary or islet cell tumour