Pancreatic carcinoma

Question 1

pathophysiology

Answer 1

90% are adenocarcinomas of head of pancreas

Question 2

risk factors?

Answer 2

• smoking
• DM (2x increase)
• chronic pancreatitis

Question 3

epidemiology

Answer 3

• 4th leading cause of cancer death
• pts typically 50-70
• Present late as do not cause symptoms unless blocking biliary system & causing painless jaundice
• incidence increasing in UK

Question 4

symptoms?

Answer 4

• non-specific upper abdo/ back pain
• painless obstructive jaundice + other symptoms of the picture
• unintentional wt loss

Question 5

mets to?

Answer 5

• liver
• peritoneum
• lung
• bones

Question 6

signs?

Answer 6

Courvoisier’s Sign: painless obstructive jaundice plus non-tender palpable gallbladder is pancreatic cancer until proven otherwise

Question 7

Ix?

Answer 7

• bloods- tumour marker
• endoscopic US w biopsy
• CT

Question 8

tumour marker?

Answer 8

CA19-9

Question 9

Mx?

Answer 9

• curative (<20% suitable)
  
  • whipple’s procedure for tumour of head of pancreas w no spread
  • distal pancreatectomy for tumour of body / tail of pancreas
• palliative: analgesia, stents etc

Question 10

prognosis?

Answer 10

v poor- approx 16% 1 year survival