Carcinoma of the Pancreas

Question 1

Description:

Answer 1

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Question 2

Aetiology/ Risk Factors: What are the risk factors of pancreatic cancer? (5)

Answer 2

Risk Factors:

• Smoking
• Alcohol
• Diabetes mellitus
• Chronic pancreatitis
• Hereditary pancreatitis

Question 3

Pathology: What are the 4 pathological types of pancreatic cancer?

Answer 3

Pathological types:

• Duct cell mucinous adenocarcinoma (75% - most common)
• Carcinosarcoma
• Acinar cell
• Cystadenocarcinoma

Question 4

Symptoms: What are the clinical symptoms of pancreatic cancer? (6)

Answer 4

• Upper abdominal pain (radiating to the back)
• Weight loss, anorexia
• Obstructive jaundice (painless)
• Fatigue
• Diarrhoea/steatorrhoea
• Nausea/vomiting

Question 5

Investigations: What imaging investigations do we perform for pancreatic cancer? (4)

Answer 5

• Ultrasound
• CT scan
• MRI scan
• Endoscopic ultrasound

Question 6

Investigations: What investigations do we perform for pancreatic cancer?

(a) General investigation (1)
(b) Tumour markers (1)
(c) Imaging investigations (7)

Answer 6

(a) Blood tests
(b) - CA19-9

(c) Imaging investigations:
- Ultrasound
- CT scan
- MRI scan
- Endoscopic ultrasound

• If mass with no jaundice then do an endoscopic ultrasound with a percutaneous needle biopsy
• If mass with jaundice then do ERCP
• Laparoscopic ultrasound (to evaluate the common bile duct)

Question 7

Treatment:
(a) How do we treat patients with pancreatic cancer? (1)

(b) How do we palliate jaundice? (1)
(c) Pain control? (3)

Answer 7

(a) Laparotomy then radical surgery - Pancreatoduodenectomy (Whipple’s procedure)
- However < 10% of patients are operable

(b) - Stenting to palliate jaundice
(c) - Opiates, radiotherapy and coeliac plexus block

Question 8

Complications:

Answer 8

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Question 9

Extra: What do we perform to assess a patient’s fitness for major pancreatic resection? (3)

Answer 9

Accessing patient fitness for major pancreatic resection:

• Basic history and examination
• CXR, ECG
• Respiratory function tests

Question 10

Extra: What conditions must a patient have to be able to undergo Whipples procedure surgery (pancreatoduodenectomy)

Answer 10

Conditions of a patient to be appropriate for Whipple’s procedure:

• Patient is fit
• No metastases
• Tumour < 3 cm