Pancreatic Carcinoma

Question 1

What type of cancer affects the pancreas?

Answer 1

Adenocarcinomas which typically occur at the head of the pancreas

Question 2

What are the risk factors of pancreatic carcinomas?

Answer 2

• Smoking
• Alcohol
• High fat diet
• Multiple endocrine neoplasia
• Diabetes
• Chronic Pancreatitis
• Adiposity
• Hereditary non-polyposis colorectal cancer
• BRCA 2 gene

Question 3

What is the differential diagnosis on Pancreatic Carcinomas?

Answer 3

• Autoimmune pancreatitis
• Chronic pancreatitis
• Gallstones
• Cholagiocarcinoma
• Ampullary Carcinoma

Question 4

What age group and gender is pancreatic cancer most prevalent in?

Answer 4

Male

> 70 years of age

Question 5

What are the clinical features of Pancreatic Carcinoma?

Answer 5

• Painless, obstructive jaundice
• Unintended weight loss
• Lymphadenopathy
• Hepatospelnomegaly
• Mid epigastric pain radiating to back (common presentation but may not be there)
• Ascites
• Steatorrhoea (loss of exocrine function - pale, difficult to flush and foul swelling stools)
• Diabetes (loss of endocrine function)

Question 6

What are the investigations in suspected Pancreatic Carcinoma?

Answer 6

=> Ultrasound or CT

CT is the choice of investigation

Question 7

What is the management of Pancreatic Carcinoma?

Answer 7

=> Majority cases involve palliative care:

• Post-op chemotherapy to delay disease progression
• ERCP with stenting
• Optimising symptom control

=> curative treatment:
Whipple’s procedure - side affects include peptic ulcer disease and dumping syndrome

Question 8

What is Courvoisier’s law?

Answer 8

In the presence of painless obstructive jaundice, a palpable gall bladder is unlikely to be due to gallstones. A common feature of Pancreatic Carcinoma