Carcinoma of the Pancreas

Question 1

Epidemiology of pancreatic cancer.

Answer 1

3% of all malignancies.

9000 deaths/yr in the UK

UK incidence is rising

Patients are often male and over 70

Question 2

Risk factors of pancreatic cancer.

Answer 2

Smoking

Alcohol

Carcinogens

DM

Chronic pancreatitis

Increased waist circumference

POssibly a high-fat and red or processed meat diet.

Question 3

Pathology of pancreatic cancer.

Answer 3

Mostly ductal adenocarcinoma - 60% arise the in head of pancreas, 25% in the body and 15% in the tail.

A few arise in the ampulla of Vater or pancreatic islet cells.

95% have mutations in the KRAS2 gene

Question 4

Pancreatic islet cell cancers.

Answer 4

Insulinoma

Gastrinoa

Glucagonoma

Somatostatinoma

VIPoma

Question 5

Clinical features of carcinoma of the pancreas

Answer 5

Painless obstructive jaundice (head)

Epigastric pain radiating to the back and relieved by sitting forward (body&tail)

Anorexia

Weight loss

Diabetes

Acute pancreatitis

Question 6

Rare features of pancreatic cancer.

Answer 6

Thrombophlebitis migrans

Hypercalcaemia

Marantic endocarditis

Portal HTN

Nephrosis

Question 7

Signs of pancreatic cancer.

Answer 7

Jaundice + palpable gallbladder

Epigastric mass

Hepatomegaly

Splenomegaly

Lymphadenopathy

Ascites

Question 8

Investigations of pancreatic cancer.

Answer 8

Bloods - LFTs, FBC, CRP, ESR, Amylase, Check for cholestatic jaundice.

Imaging - CT or US, ERCP/MRCP, EUS

Biopsy

Question 9

Imaging findings of pancreatic cancer.

Answer 9

Pancreatic mass +/- dilated biliary tree +/- hepatic metastases.

ERCP/MRCP can guide biopsy and help staging prior to surgery/stent insertion.

EUS (endoscopic sonography) is an emerging adjunct for diagnosis and staging.

Question 10

Treatment of pancreatic cancer.

Answer 10

Surgery (Whipple’s procedure) only where no distant metastases are found.

Laparoscopic excision.

Post-op chemotherapy.

Pain relief

Palliation of jaundice