Pancreatic tumours Flashcards
What are the risk factors for pancreatic cancer?
S - Smoking I - Inflammation (Chronic pancreatitis) N - Nutrition (High fat diet) E - Ethanol D - Diabetes
What are the majority of pancreatic carcinomas?
Ductal adenocarcinomas
Where are most pancreatic carcinomas?
60% = Head of the pancreas 25% = Body of the pancreas 15% = Tail of the pancreas
Why is the prognosis for pancreatic cancer so poor?
They present late and metastasise early (Local structures, lymphatics, bloodstream to liver and lungs)
What is the classic presentation of pancreatic carcinoma?
Epigastric pain (Relieved by sitting forward, radiating to the back)
Painless obstructive jaundice (Dark urine, pale stools)
Weight loss
Malabsorption
What are some of the signs of pancreatic cancer?
Jaundice Palpable epigastric mass Ascites May have palpable gall bladder Trousseau sign (Thrombophlebitis migrans on skin)
What investigations can be done in a patient with suspected pancreatic cancer?
Bloods - Anaemia
USS - Dilated bile ducts, mass/lesion
Staging CT
What is the management of pancreatic cancer?
ERCP - Stenting the bile ducts for palliative treatment
MDT approach
Surgical resection if possible - but rarely possible (Whipples procedure)
Coeliac plexus block if pain very bad
Chemotherapy/Radiotherapy
Can help with obstructive jaundice and pain
What is Courvoisier’s Law?
In the presence of painless obstructive jaundice, a
palpable gallbladder is unlikely to be due to stones
What are the signs of an Insulinoma?
Fasting/exercise induced hypoglycaemia
Confusion, loss of consciousness
Increased insulin and c-peptide with decreased glucose on blood test
What are the signs of a Gastrinoma/Zollinger Ellison syndrome?
Hypergastrinaemia
Peptic ulcer disease
Chronic diarrhoea
What are the signs of a Glucagonoma?
Increase in serum glucagon
Mild Diabetes
Characteristic blistering rash (Necrolytic migratory erythema)
