Pancreatic Carcinoma

Question 1

What and where are most types of pancreatic carcinomas?

Answer 1

90% adenocarcinomas

Head of pancreas

Question 2

Why do pancreatic carcinomas present late?

Answer 2

Don’t cause symptoms until biliary system blockage -> painless jaundice

Question 3

Where do they metastasize to?

Answer 3

liver
peritoneum
lungs
bone

Question 4

What is the 5 year survival for early disease?

Answer 4

25%

Question 5

How does pancreatic cancer present?

Answer 5

• Non-specific upper abdominal/back pain
• Painless obstructive jaundice
• Unintentional weight loss
• Pale stools (due to lack of bile)
• Steatorrhoea (greasy stools due to malabsorption due to lack of bile)
• Dark urine (due to obstructive jaundice)
• Palpable mass in epigastric region

Question 6

What tumour marker is useful for pancreatic carcinoma?

Answer 6

CA19-9

Question 7

What can be used to diagnose parcreatic carcinoma?

Answer 7

• CT scan (including thorax, abdomen and pelvis for staging)

* Endoscopic ultrasound with biopsy

Question 8

what is Courvoisier’s law?

Answer 8

Courvoisier’s law

•Painless jaundice plus a non-tender palpable gallbladder is pancreatic cancer until proven otherwise

Question 9

What is a Whipple’s procedure?

Answer 9

• Requires the patient the be in good baseline health
• For tumour of head of pancreas with no spread
• Involves removing head of pancreas, gallbladder, duodenum and pylorus
• Modified Whipple’s involves leaving the pylorus, and has equal success rates to traditional Whipples

Question 10

What late disease management is there?

Answer 10

• Palliative chemotherapy may be offered if fit to attempt to extend life
• Palliative stenting of bile ducts to relive obstruction
• Palliative care