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Clinical Alimentary System > 4.3. Pancreatic Disease - Carcinoma of the Pancreas > Flashcards

4.3. Pancreatic Disease - Carcinoma of the Pancreas Flashcards

1
Q

What is happening to the Incidence of Pancreatic Carcinoma?

A

It is increasing

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2
Q

Is Pancreatic Carcinoma more common in Males or Females?

A

Males

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3
Q

In what age group is Pancreatic Carcinoma most commonly found?

A

60-80 year olds

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4
Q

What are risk factors for Pancreatic Cancer?

A
  1. Smoking
  2. Excessive Alcoholism
  3. Excessive intake of Coffee and Aspirin
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5
Q

What types of Pancreatic Carcinoma are there?

A
  1. Duct Cell Mucinous Adenocarcinoma (75% of cases)
  2. Acinar Cell Adenocarcinoma (5% of cases)
  3. Carcinosarcoma (Rare)
  4. Cystadenocarcinoma (Rare)
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6
Q

What causes the Dysplasia of Pancreatic Cells?

A

Successive Accumulation of Gene Mutations

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7
Q

In what sites do Duct Cell Mucinous Adenocarcinoma (DCMA’s) occur?

A
  1. The Head of the Pancreas (60% of DCMA’s)
  2. The Body of the Pancreas (13% of DCMA’s)
  3. The Tail of the Pancreas (5% of DCMA’s)
  4. Multiple Sites (22% of DCMA’s)
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8
Q

Where does the Pancreatic Cancer originate?

A

The Ductal Cell Epithelum

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9
Q

What does the Pancreatic Carcinoma evolve from / to?

A

From - Premalignant Lesion

To - Fully Invasive Cancer

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10
Q

What are the Clinical Signs of Pancreatic Carcinoma in the Head of the Pancreas?

A
  1. Jaundice
  2. Scratch Marks
  3. A Palpable Gallbladder and Cholestatic Signs
  4. A Palpable Mass
  5. Thrombophlebitis Migrans
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11
Q

What are the Clinical Signs of Pancreatic Carcinoma in the Body / Tail of the Pancreas?

A
  1. None (Most common)
  2. Thromboembolic Phenomina / Polyarthiritis
  3. Skin Nodules
  4. Lymphadenopathy
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12
Q

What causes the Jaundice / Palpable Gallbladder and Cholestatic Signs in Carcinoma of the Head of the Pancreas?

A

The Carcinoma Obstructing the Common Bile Duct

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13
Q

What causes the Dermatological Scratch Marks / Hepatomegaly occur in Carcinoma of the Head of the Pancreas?

A

These are Secondary to Cholestatic Symptoms - Due to the Liver Dysfunction and Hyperbilirubinaemia

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14
Q

What is Thrombophlebitis Migrans? And why does it occur in Carcinoma of the Head of the Pancreas?

A

A Migrating Vein Inflammation due to the potential of portal hypertension

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15
Q

Why does Thromboembolic Phenomina / Polyarthiritis occur in Carcinoma in the Body / Tail of the Pancreas?

A

This is not fully understood

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16
Q

Why do Skin Nodules appear in Carcinoma in the Body / Tail of the Pancreas?

A

These are secondary to the Localized Fat Necrosis and the associated Inflammation

17
Q

Which Lymph Node involvement suggests Aggressive Carcinoma in the Body / Tail of the Pancreas?

A

Supraclavicular Lymphadenopathy

18
Q

What are the Symptoms caused by Pancreatic Carcinoma?

A
  1. Painless (Pain may arise in Late-Stage)
  2. Pancreatitis Symptoms
  3. Steatorrhoea
  4. Epigastric Pain
  5. Weight Loss
  6. Fatigue
19
Q

Why might Pancreatitis Symptoms occur in Pancreatic Carcinoma?

A

Symptomatic Episodes of Pancreatitis may be associated with the Blockage of the Pancreatic Duct

20
Q

Why might Weight Loss / Steatorrhoea occur in Pancreatic Carcinoma?

A

Due to the Malabsorption caused by the associated Exocrine Deficiency of Pancreatic Carcinoma

21
Q

What can relieve the Epigastic Pain associated with a Pancreatic Tumour of the Body of the Pancreas?

A

Leaning forward

22
Q

What is the Order of Investigations which occur with Clinical Suspicion of Pancreatic Carcinoma?

A
  1. (Abdominal / Endoscopic) Ultrasound / CT Scan
    2a) For Jaundice with a Mass - ERCP + Stenting
    2b) For Jaundice without a Mass - Endoscopic Ultrasound / Percutaneous Needle Biopsy
    Note - 2a is followed by 2b
  2. After the Carcinoma has been diagnosed - CT Scan / Endoscopic Ultrasound / Laparoscopy - to determine if the Cancer is Operable
23
Q

What is a Laparoscopy?

A

A Fibre-Optic Instrument inserted through the Wall of the Abdomen to view the External Pancreas

24
Q

What is the treatment of the Pancreatic Carcinoma?

A
  1. Whipples Procedure (Pancreatoduodenectomy)
  2. Cholechoduodenostomy
  3. Palliative Care
25
Q

What percentage of Pancreatic Carcinoma’s are operable?

A

Less than 10%

26
Q

What does Whipples Procedure (Pancreatoduodectomy) involve?

A

This Radical Surgery involves the removal of both the Pancreas and the Duodenum

27
Q

Who can Whipples Procedure (Pancreatoduodenectomy) be done on?

A
  1. If the patient is fit
  2. If there is no Metastases
  3. If the Tumour is less than 3cm in diameter
28
Q

What is a Cholechoduodenostomy?

A

The anastomosis of the Common Bile Duct, to relieve symptoms - this is palliative surgery

29
Q

What does Palliative care involve?

A
  1. Opiates / Coeliac Plexus Block - For Pain relief
  2. Stenting - For Symptomatic Relief of Cholestasis Symptoms
  3. Radiotherapy / Chemotherapy - to alleviate some symptoms
30
Q

What is the Survival Rate of Inoperable Cases?

A

1% 1 year survival

Mean Survival = 6 months

31
Q

What is the Survival Rate of Operable Cases?

A

15% 1 year survival

Clinical Alimentary System (64 decks)

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