Pancreatic cancer Flashcards
1
Q
When is pancreatic cancer usually diagnosed? (time scale)
A
Pancreatic cancer is often diagnosed late as it tends to present in a non-specific way. Over 80% of pancreatic tumours areadenocarcinomas which typically occur at the head of the pancreas.
2
Q
risk factors: pancreatic cancer
A
- increasing age
- smoking
- diabetes
- chronic pancreatitis (alcohol does not appear an independent risk factor though)
- hereditary non-polyposis colorectal carcinoma
- multiple endocrine neoplasia
- BRCA2 gene
- KRAS gene mutation
3
Q
Features of pancreatic cancer
A
CLASSIC PAINLESS JAUNDICE
- pale stools, dark urine, and pruritus - cholestatic liver function tests
- Courvoisier’s lawstates that in the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones
- however, patients typically present in a non-specific way with anorexia, weight loss, epigastric pain
- loss of exocrine function (e.g. steatorrhoea)
- loss of endocrine function (e.g.diabetes mellitus)
- atypical back pain is often seen
- migratory thrombophlebitis (Trousseau sign) is more common than with other cancers
4
Q
Investigation: pancreatic cancer
A
- ultrasound has a sensitivity of around 60-90%
- high-resolution CT scanning is the investigation of choiceif the diagnosis is suspected
- imaging may demonstrate the’double duct’ sign- the presence of simultaneous dilatation of the common bile and pancreatic ducts
5
Q
Management: pancreatic cancer
A
- less than 20% are suitable for surgery at diagnosis
- a Whipple’s resection (pancreaticoduodenectomy) is performed for resectable lesions in the head of pancreas. Side-effects of a Whipple’s include dumping syndrome and peptic ulcer disease
- adjuvant chemotherapy is usually given following surgery
- ERCP with stenting is often used for palliation
6
Q
A 70 year old man presents with anorexia, weight loss and painless jaundice, is a common presentation of?
A
Pancreatic cancer
