pancreatic carcinoma Flashcards
definition of pancreatic cancer
malignancy from the exocrine or endocrine tissues of the pancreas
aetiology of pancreatic cancer
unknown
5-10% are hereditory - MEN, HNPCC, FAP, Gardner, von-Hippel-Lindau
RF for pancreatic cancer
increasing age
smoking
alcohol
DM
chronic pancreatitis
high waist circumference
dietary factors (low in fresh fruit and veg, high fat and red/processed meat)
carcinogens
epidemiology of pancreatic cancer
increasing incidence (8-12/100000)
2x more in men
60-80yrs
3% of all malignancy
9000 deaths/yr UK
sx of pancreatic ca
initial sx non-specific
- anorexia
- malaise
- nausea
- epigastric pain (body and tail) - radiates to the back, relieved when sitting forward
later - weight loss, anorexia, DM, jaundice (head), acute pancreatitis
signs of pancreatic ca
signs of weight loss
epigastric tenderness or mass
jaundice and palpable gallbladder (courvoisier’s law)
hepatomegaly if mets
splenomegaly
lymphadenopathy
ascites
trousseau’s sign - associated superficial thrombophlemitis
macro pathology of pancreatic ca
75% in neck or head of pancreas (present as a periampullary tumour)
15-20% occur in the body
5-10% occur in tail
a few in the ampulla of vater (ampullary tumour)
pancreatic islet cells (insulinoma, gastrinoma, glucagonomas, somatostatinomas, VIPomas)
ampullary and islet cell tumours have better prognosis
spread is local and to the liver
micro pathology of pancreatic ca
80% adenocarcinomas of the ductal epithelium - met early, present late
others - adenosquamous, mucinous, cystadenocarcinomas
endocrine tumours - insulinomas, glucagonomas, gastrinomas
bloods for pancreatic ca
tumour markers - CA19-9 (assess prognosis), CEA elevated - neither diagnostic
if causing obstructive jaundice = high BR, ALP, clotting may be deranged
imaging for pancreatic ca
staging:
- US
- CT +- guided biopsy
- MRI and MRCP
CT and US - guide biopsy. show mass +- dilated tree +- hepatic met
ERCP - allow biopsy/bile cytology +- stenting
MRCP and ERCP - biliary tree anatomy and localise site of obstruction
Ix for pancreatic cancer
bloods
imaging
staging laproscopy or intraoperative US
endoscopic sonography emerging adjunct for dx and staging
rare features of pancreatic ca
thrombophlebitis migrans - arm vein becomes swollen and red, then a leg vein
hupercalcaemia
marantic endocarditis
portal hypertension (splenic vein thrombosis)
neprosis (renal vein met)
courvoisier’s law
palpable gallblasser with painless jaundice - unlikely to be gallstones
