Pancreatic Neoplasms Flashcards
What percentage of pancreatic cancers are pancreatic ductal adenocarcinomas
More than 85%
What percentage of pancreatic adenocarcinomas occur between the ages of 60- 80 years old
80%
What percentage of pancreatic ductal carcinomas occur in the head of the pancreas
65%
What are the well defined cancer predisposing syndromes that patients with pancreatic adenocarcinoma may present with
- hereditary non-polyposis colon cancer
- familial breast cancer
- familial syndrome adenomatous polyposis
- peutz-jeugers
Risk factors for the development of pancreatic cancer
- predisposing cancer syndrome
- smoking
- chronic pancreatitis
- possible risk factors: diabetes meillitus, obesity
Clinical presentation of pancreatic cancer (History)
- Painless obstructive jaundice: cancer of the head of the pancreas
- Upper abdominal pain that radiates to the back, mimic peptic ulcer disease and irritable bowel syndrome
- Weight loss
- Late onset diabetes (atypical diabetes)
- Gastric outlet obstruction
- Ascites
- Abdominal mass
- Thrombophlebitis migrans
- Dyspepsia
Features of advanced disease in pancreatic cancer
- Virchow’s node
- Sister Mary Joseph Nodule
Lab studies done in suspected pancreatic neoplasms
- Rise in serum bilirubin, ALP and GGT
- High CA 19-9 is the most useful tumour marker
Uses of trans-abdominal ultrasound in the work up for pancreatic cancer
- First line investigation in patietn with jaundice
- Detects biliary and pancreatic duct dilation (double duct sign), Liver metastasis and ascites
- Not good at detecting pancreatic masses less than 2 cm in size or assessment of vascular invasion
Radiological investigation of choice in pancreatic cancer
Multiphase, helical computed tomography
When is ERCP done in work up for pancreatic cancer
-Reserved for palliative billiary stenting or when there is a suspicion of periampullary tumour
When is a staging laparoscopy done
- Equivocal CT findings
- marked weight loss
- Severe pain
- markedly elevated CA19-9 levels
- It is used to detect as yet undiagnosed peritoneal deposits or liver metastasis
Factors contraindicating surgical resection of pancreatic neoplasm
- Presence of metastatic disease
- Lymph node involvement
- major vessel involvement (SMA, coelic artery, hepatic artery, portal or superior mesenteric veins
- Comorbid disease
What procedure is used for resection of tumors in the head or ucinate process of pancreas
Pancreaticoduodenectomy (Whipple’s procedure)
What procedure is used for resection of tumors in the body and tail of the pancreas
distal pancreatectomy
What three anastomosis are done in a whipples procedure
- Hepaticojejenostomy
- Pancreaticojejenostomy
- Gastrojejenostomy
Most common complications of pancreatic resection
- Pancreatic fistula
- Intra-abdominal collections
- Haemorrhage
- Delayed gastric emptying
When should preoperative biliary decompression be considered in pancreatic cancer
- Cholangitis
- Advanced malnutrition
- Significant time delay before surgery
Which symptoms most commonly need treatment in the palliative treatment of pancreatic cancer, how do you manage them?
- Obstructive jaundice: endoscopically placed stent / hepaticojejenostomy
- Gastric outlet obstruction: endoscopic duodenal stenting/ Gastrojejenostomy
- Pain: opiates, NSAIDS, coeliac plexus block
What adjuvant therapy is used in pancreatic cancer
Adjuvant gemcitabine chemotherapy
epidemiology of insulinomas
- Male:female - 2:1
- Most common in patients 40 - 50 years old
Whipple’s triad in insulinoma
- Symptoms of hypoglycaemia
- Concomitant blood glucose level of <5 mmol/L
- Relief of hypoglycemia with glucose administration
How is the diagnosis of insulinoma confirmed
-Elevatated c peptide levels and insulin levels during episode hypoglycemia
Most sensitive test for localising insulinomas
Endoscopic ultrasonography
