Pancreatic Cancer

Question 1

How many people does pancreatic cancer affect. (2)

Answer 1

10-15/100,000 in Western populations.

Rising to 100/100,000 in those over 70.

Question 2

How many people does pancreatic cancer affect. (2)

Answer 2

10-15/100,000 in Western populations.

Rising to 100/100,000 in those over 70.

Question 3

What percentage of malignancies are pancreatic cancer.

Question 4

How many deaths per year does pancreatic cancer cause in the UK.

Answer 4

6500 per year.

Question 5

What are the two main features of a typical patient presenting with pancreatic cancer. (2)

Answer 5

> 60.

Male.

Question 6

What are the risk factors for pancreatic cancer. (7)

Answer 6

Smoking. 
Alcohol. 
Carcinogens. 
DM. 
Chronic pancreatitis. 
Increased waist circumference (ie adiposity). 
High pat and red or processed meat diet.

Question 7

What are the pathological features of pancreatic cancer. (6)

Answer 7

Mostly ductal adenocarcinoma.
60% arise in the pancreas head, 25% in the body, 15% in the tail.
A few arise in the ampulla of Vater (ampullary tumour) or pancreatic islet cells - both of these have a better prognosis.

Question 8

What are the features of ductal adenocarcinomas. (2)

Answer 8

Metastasise early.

Present late.

Question 9

What mutation is associated with pancreatic tumours. (2)

Answer 9

95% have mutations in the KRAS2 gene.

5-10% of patients have a genetic predisposition (eg hereditary pancreatitis, MEN).

Question 10

How do tumours in the head of the pancreas present (and also the ampulla of Vater). (2)

Answer 10

Painless obstructive jaundice.

Often with severe pruritis.

Question 11

How do tumours in the head of the pancreas present.

Answer 11

Painless obstructive jaundice.

Question 12

How do tumours in the body and tail of the pancreas present. (3)

Answer 12

75% present with epigastric pain.

The pain radiates to the back and is relieved by sitting forward.

Question 13

What are some typical features of pancreatic cancer. (4)

Answer 13

Weight loss.
Anorexia.
Diabetes.
Acute pancreatitis.

Question 14

What are some of the rarer features of pancreatic cancer. (5)

Answer 14

Thrombophlebitis migrans (an arm vein becomes swollen and red, then a leg vein).
Raised calcium.
Marantic endocarditis.
Portal hypertension (splenic vein thrombosis).
Nephrosis (renal vein metastases).

Question 15

What are some of the signs of pancreatic cancer on physical exam. (7)

Answer 15

Jaundice and palpable gallbladder (Courvoisier's law). 
Epigastric mass. 
Hepatomegaly. 
Splenomegaly. 
Lymphadenopathy. 
Ascites.

Question 16

What is the median survival rate for patients with pancreatic cancer. (2)

Answer 16

6-10 months for those with locally advanced disease.

3-5 months if metastases are present.

Question 17

What is the median survival rate for patients with pancreatic cancer. (2)

Answer 17

6-10 months for those with locally advanced disease.

3-5 months if metastases are present.

Question 18

What percentage of malignancies are pancreatic cancer.

Question 19

How many deaths per year does pancreatic cancer cause in the UK.

Answer 19

6500 per year.

Question 20

What are the two main features of a typical patient presenting with pancreatic cancer. (2)

Answer 20

> 60.

Male.

Question 21

What are the risk factors for pancreatic cancer. (7)

Answer 21

Smoking. 
Alcohol. 
Carcinogens. 
DM. 
Chronic pancreatitis. 
Increased waist circumference (ie adiposity). 
High pat and red or processed meat diet.

Question 22

What are the pathological features of pancreatic cancer. (6)

Answer 22

Mostly ductal adenocarcinoma.
60% arise in the pancreas head, 25% in the body, 15% in the tail.
A few arise in the ampulla of Vater (ampullary tumour) or pancreatic islet cells - both of these have a better prognosis.

Question 23

What are the features of ductal adenocarcinomas. (2)

Answer 23

Metastasise early.

Present late.

Question 24

What are some examples of pancreatic islet cell tumours. (3)

Answer 24

Insulinoma.
Gastrinoma.
Glucagonomas.

Question 25

What mutation is associated with pancreatic tumours.

Answer 25

95% have mutations in the KRAS2 gene.

Question 26

How do tumours in the head of the pancreas present.

Answer 26

Painless obstructive jaundice.

Question 27

How do tumours in the body and tail of the pancreas present. (3)

Answer 27

75% present with epigastric pain.

The pain radiates to the back and is relieved by sitting forward.

Question 28

What are some typical features of pancreatic cancer. (4)

Answer 28

Weight loss.
Anorexia.
Diabetes.
Acute pancreatitis.

Question 29

What are some of the rarer features of pancreatic cancer. (5)

Answer 29

Thrombophlebitis migrans (an arm vein becomes swollen and red, then a leg vein).
Raised calcium.
Marantic endocarditis.
Portal hypertension (splenic vein thrombosis).
Nephrosis (renal vein metastases).

Question 30

What are some of the signs of pancreatic cancer on physical exam. (7)

Answer 30

Jaundice and palpable gallbladder (Courvoisier's law). 
Epigastric mass. 
Hepatomegaly. 
Splenomegaly. 
Lymphadenopathy. 
Ascites.

Question 31

What is the overall survival for pancreatic cancer.

Answer 31

3-5%.

Question 32

What is the median survival rate for patients with pancreatic cancer. (2)

Answer 32

6-10 months for those with locally advanced disease.

3-5 months if metastases are present.

Question 33

What percentage of pancreatic tumours are adenocarcinomas.

Answer 33

90%.

Question 34

What is the pain caused by pancreatic cancer typically described as. (4)

Answer 34

Incessant and gnawing.

It often radiated to the back and may be eased a little by bending forward.

Question 35

How is a diagnosis of pancreatic cancer often made. (2)

Answer 35

Ultrasound and contrast enhanced CT.

Question 36

What is a rare presentation of pancreatic cancer.

Answer 36

Recurrent episodes of typical acute pancreatitis.