Pancreatic Carcinoma Flashcards
What is it?
Cancer of the Pancreas
What type of cancer causes it?
Usually caused by Ductal Adenocarcinoma
Where does it occur?
It can occur throughout the entire pancreas, 60% in the head, 23% the body, 15% the tail. Some may arise in the Ampulla of Vater or Pancreatic Islet Cells (insulinoma, Gastrinoma, Glucagonoma)
Is there a genetic link?
Yes, 95% of cases have mutations in the KRAS2 gene
Is it common?
No, it causes <2% of all UK malignancies, but causes 6500 deaths per year
Who does it affect?
Typically males over 60 years old
Risk factors
Smoking, alcohol, carcinogens, diabetes, chronic pancreatitis, raised waist circumference, high fat diet, red/processed meat
Symptoms (6)
Pancreatic head tumours cause painless obstructive jaundice (they compress the common bile duct), 75% of body and tail tumours cause epigastric pain which radiates to the back (relieved by sitting forward), anorexia, weight loss, acute pancreatitis
Signs (7)
new onset of diabetes, hypercalcaemia, lymphadenopathy, portal hypertension, jaundice, epigastric mass, hepato and splenomegaly
Differentials
Dyspepsia, Gastritis, Acute/Chronic Pancreatitis, Gallstone, Common bile duct stone
What bloods would you do? (9)
FBC, ESR, CRP, Serum Amylase, Serum Lipase, U&E, LFT, Calcium, Ca19-9 bloods (blood test shows cholestatic jaundice i.e normal liver enzymes but raised Alk Phos and Bilirubin)
Other investigations (5)
Ultrasound, CT, Endoscopic Ultrasound, MRCP/ERCP, Biopsy
Treatment (5)
*Often metastasises early and presents late, radical pancreatoduodenectomy (only 20% suitable)-known as whipple’s procedure, post op chemotherapy, stenting to relieve jaundice, analgesia with opiates, palliative radiotherapy
Is there a good prognosis?
Mean survival <6months, 5 year survival <3%, 5 year survival after whipples is 5-14%
