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HPB Surgery > Pancreatic Cancer > Flashcards

Pancreatic Cancer Flashcards

1
Q

At what age group does most pancreatic cancers occur?

A

60-80 yrs

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2
Q

What is the most common type of pancreatic cancer?

A

Ductal carcinoma - arises from exocrine portion of gland - 90%

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3
Q

What are the remaing less common pancreatic cancers?

A

Exocrine tumours - pancreatic cystic carcinoma

Endocrine tumours - from islet cells

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4
Q

Where in the pancreas are pancreatic cancers most common?

A

Head of pancreas - 60-70%

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5
Q

Where else can cancers occur in the pancreas?

A

Body and tail

Diffuley invlove the pancreas

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6
Q

Why are pancreatic cancers in the body and tail more likely to be diagnosed at an advanced stage?

A

Less likely to have Obstructive symptoms

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7
Q

What are the risk factors for pancreatic cancers?

A

Smoking
Chronic pancreatitis
Dietary factors (high red meat intake, low fruit and vegtable intake)
FH
Late onset DM - 8x more risk if diagnosed >50 yrs of age

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8
Q

What is a red flag for pancreatic cancers?

A

Painless jaundice

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9
Q

What are some of the presenting features of pancreatic cancers?

A

80% unresctable at diagnosis as vague symptoms:

Obstructive jaundice
Weight loss
Abdominal pain

Examination - cachetic, malnourished and jaundiced. Abdominal mass in epigastric region as well as an enlarged gallbldder. (Courvoisiers law)

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10
Q

What some less common presentations of pancreatic cancers?

A

Acute pancreatitis

Thrombophlebitis migrans

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11
Q

What are the differential diagnosis of pancreatic cancers?

A

Causes of obstructive jaundice - gallstone disease, cholangiocarcinoma

Epigastric abdominal pain - PUD, gastri cancer, ACS

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12
Q

What is the tumour marker specfic for pancreatic cancers and what is its role?

A

CA19-9

Assessing response to treatment rather then intial diagnosis

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13
Q

Other then bloods what investigations sould be ordered for pancreatic cancers?

A

Abdominal ultrasound - pancreatic mass or dilated bilary tree

CT imaging (pnacreatic protacol) - GOLD standard to diagnose

Staging CT

PET scan or MRCP may be useful in unclear diagnosis

EUS - endoscopic ultrasound for staging, biposy and histology

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14
Q

What is the curative management option for pancreatic adenocarcinoma?

A

Radical resection

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15
Q

How can pancreatic cancers be classifed?

A

Resectable
Borderline resctable

Unresectable:
Locally advanced - depending on contact with surrounding vessels
Metastatic

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16
Q

What is the surgery of choice for pancreatic cancers located in the head of the pancreas?

A

Pancreaticoduodenectomy (Whipples procedure) with regional lymphadenectomy

17
Q

What is the surgery of choice for pancreatic cancers loctaed in the body or tail of pancreas?

A

Distal pancreatectomy +/- splenectomy with reginol lymphadenopathy

18
Q

What are specific complications of pancreatic cancer surgery?

A

Pancreatic fistula
Delayed gastric emptying
Pancreatic insufficiency

19
Q

What should all surgical patients recieve after pancreatic cancer surgery?

A

Adjuvant chemotherapy

20
Q

What is removed in whipples procedure and why?

A 
Head of the pnacreas 
Antrum of stomach 
1st and 2nd parts of duodenum
Common bile duct 
Gallbladder

All due to their common blood supply - gastroduodenal artery

21
Q

What happens after removal in whipples procedure?

A

Tail of pancreas and heaptic duct joined to jejunum. Stomach anastomosis with the jejunum

22
Q

What is the management for non resectable tumours?

A

Chemotherapy - Gemcitabine

Metastatic disease - good performance status - FOLFIRINOX, or gemcitabine if cant tolerate

Symptomatic management if poor performance status - obstruction relived by inserting biliary stent. Exocrine insufficiency- enzyme replacemnts(Creon)

23
Q

What are the two classiications of endocrine pancreatic cancers?

A

Functional - secrete hormones - signs and symptoms related to this

Non-functional - dont secrete hormones and clinical features purely malginant spread

Often associated with Multiple endocrine neoplasia 1 syndrome (MEN1)

24
Q

What does MEN1 typically consist of?

A

Hyperparathyrosim
Endocrine pancreatic tumours
Pituitary tumours

25
Q

What is the management of endocrine pancreatic cancers?

A

Blood tests to identify specfic subtype
CT imaging, MRI imaging and EUS

Observe and resect

Somatostain analogues could be used

26
Q

Which hormone is in excess in Zollinger-Ellison syndrome?

A

Gastrin

HPB Surgery (6 decks)

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