Pancreatic carcinoma

Question 1

Risk factors for pancreatic carcinoma?

Answer 1

• DINES
  
  • Smoking
  • Inflammation (chronic pancreatitis)
  • Nutrition (high fat diet)
  • Ethanol
  • DM

Question 2

Describe the pathology of pancreatic carcinoma?

Answer 2

• Ductal adenocarcinomas (90%)
• Presents late: early mets
  
  • Direct extension into local structures
  • Lymphatics
  • Blood -> liver and lungs

Question 3

Describe the presentation of pancreatic carcinoma?

Answer 3

• Males >60 yrs old
• Painless, obstructive jaundice
  
  • dark urine, pale stools
• Epigastric pain
• Anorexia, weight loss, malabsorption
• Acute pancreatitis
• Sudden onset DM in the elderly

Question 4

Clinical signs of pancreatic carcinoma?

Answer 4

• Palpable gallbladder
• Jaundice
• Splenomegaly
• Thrombophlebitis migrans (Trousseau sign)
• Ascites

Question 5

What is Courvoisier’s Law?

Answer 5

In the presence of a non-tender palpable gallbladder, a painless jaundice is unlikely to be due to stones

Question 6

Investigations into pancreatic carcinoma?

Answer 6

• Bloods: cholestatic LFTs, raised calcium
• Imaging:
  
  • CT +/- MRCP
  • US: pancreatic mass, dilated ducts, hepatic mets, guide biopsy
• ERCP:
  
  • Shows anatomy
  • Allows stenting
  • Biopsy of peri-ampullary lesions

Question 7

Treatment for pancreatic carcinoma?

Answer 7

• Surgery:
  
  • Fit, no mets, tumour =<3cm
  • Whipples pancreatectomy
  • Post-op chemo delays progression
• Palliation
  
  • Endoscopic stenting of bile ducts
  • Palliative bypass surgeries

Question 8

Prognosis for pancreatic carcinoma?

Answer 8

Mean survival < 6 months

Question 9

Clinical features of a head of the pancreas tumour?

Answer 9

Painless, progressive. jaundice with weight loss

Question 10

What is Trousseau’s sign?

Answer 10

• Thrombophlebitis migrans in a patient with pancreatic carcinoma
• Non-metastatic manifestation of malignancy
• Clots appearing in different parts of the body over time