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HPB > Pancreatic Neoplasms > Flashcards

Pancreatic Neoplasms Flashcards

1
Q

What are the risk factors for pancreatic adenocarcinoma?

A 
>60
Smoking
Alcohol
Diabetes
Chronic pancreatitis
Genetics
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2
Q

What affects the presentation of pancreatic adenocarcinoma?

A

Location of tumour

Both can present as acute pancreatitis/diabetes

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3
Q

How do carcinomas of the pancreatic head present?

A 
Presente earlier w/ painless jaundice
Signs related to obstructive jaundice
   -Courvoisier's sign
   -palpable abdo mass
   -hepatosplenomegaly
   -ascites
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4
Q

How do carcinomas of the body/tail of the pancreas present?

A

Present later w/ dull abdominal pain radiating to back (relieved by sitting forwards)
Non specific sx common

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5
Q

What are the common pancreatic neoplasms?

A

Ductal adenocarcinomas

  • 60% in head
  • 25% in body
  • 15% in tail
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6
Q

Describe islet cell tumours

A

<2% pancreatic neoplasms

Sx. relate to secreted hormone

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7
Q

What are the five types of islet cell tumour?

A 
Insulinoma
Glucagonoma
Gastrinoma
Somatostatinoma
VIPoma
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8
Q

What is the prognosis of pancreatic carcinomas?

A

Mean survival <6/12
5 yr survival <2%
-rises to 5-15% following Whippet’s

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9
Q

What pancreatic carcinomas have a better prognosis?

A

Ampullary/islet cell tumours (present early)

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10
Q

How do Insulinomas present?

A

Symptomatic hypoglycaemic events
Gross weight gain
90% benign

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11
Q

How do Glucagonomas present?

A

Often asymptoamtic

Secondary DM

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12
Q

How do Gastrinomas present?

A

Zollinger-Ellison syndrome

  • oesophagitis
  • GI ulcers
  • diarrhoea
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13
Q

How do Somatostatinomas present?

A

DM
Achlorrhydria
Gallstones

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14
Q

How do VIPomas present?

A

Vasoactive intestinal peptide release causes profound diarrhoea

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15
Q

What is Trousseau’s syndrome?

A

Thrombosis of superficial/deep leg veins (thrombophlebitis migrans) related to pancreatic carcinoma

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16
Q

What investigations are appropriate in suspected pancreatic carcinoma?

A 
Bloods - FBC, U&Es, LFTs, CA 19.9/CEA, amylase
USS
CT
Endoscopic USS +/- biopsy
Staging laproscopy
17
Q

What are the indications for Whipple’s procedure?

A

10-15% suitable

  • <3cm 1o
  • no mets
  • fit pt
18
Q

What is Whipple’s procedure?

A

Pancreatoduodenectomy

  • portion of pancreas, duodenum, gall bladder & bile duct removed
  • remaining organs reattached
19
Q

What is the morbidity/mortality of Whipple’s?

A

Post op mortality (5%)
-post op chemo can increase survival
Post op morbidity high

20
Q

What non-Whipple’s managmeent options are there for pancreatic carcinoma?

A

Non-curative surgery provides no survival benefit
ERCP/PTC stent may help jaundice/anorexia
Careful management of endocrine/exocrine derangements

21
Q

What is the prognosis of pancreatic neoplasms?

A

Mean survival <6mo
5yr survival <2%
-5-15% post Whipple’s

HPB (7 decks)

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