Pancreatic Cancer Flashcards
what type of cancer are most pancreatic cancers
adenocarcinoma
summary of epidemiology
Most common presentation is at 65 to 75 years of age with painless obstructive jaundice and weight loss. Generally presents late with advanced disease.
what are some risk factors for pancreatic cancer
smoking, alcohol, FHx, diabetes, obesity, hereditary cancer syndromes
how does pancreatic cancer present (early stages)
generalised symptoms of malaise, abdominal pain, nausea or weight loss.
how does advanced pancreatic cancer present
Blockage of common bile duct from a tumour in the pancreatic head leads to obstructive jaundice. Courvoisier’s sign refers to painless palpable gallbladder with jaundice.
Diabetes mellitus can be a presentation of a tumour in the body/tail of the pancreas
LOSING weight
Infiltration into the pancreas can lead to:
Unexplained pancreatitis
Pancreatic exocrine dysfunction with steatorrhoea
Paraneoplastic syndromes
Trousseau’s syndrome – migratory thrombophlebitis affecting the extremities of the body
Disseminated intravascular coagulation (DIC)
summary of presenting symptoms of pancreatic cancer
weight loss, jaundice, back pain, upper abdominal pain, positive courvoisiers sign and trousseaus sign
investigations
Painless obstructive jaundice is a red flag symptom of pancreatic carcinoma and should be investigated urgently. This is evidenced by raised bilirubin in association with raised ALP. Other investigations include:
CT abdomen/pelvis
Magnetic resonance cholangiopancreatography (MRCP) gives information about the biliary ducts
Endoscopic ultrasound
what is the most curative treatment
surgical resection of the pancreatic adenocarcinoma; however, as pancreatic cancer presents quite late, resection isnt an option
what are contraindications for surgical resection of pancreatic adenocarcinoma
no invasion of the superior mesenteric artery or coeliac arteries,
no evidence of distant metastases
what procedure is used to resect the head of the pancreas
radical pancreaticoduodenectomy (Kausch-Whipple procedure)
adjuvant chemo given after surgery
