Pancreatic Cancer Flashcards
(17 cards)
Where are most Pancreatic cancers located in the pancreas? Are they exocrine or endocrine? What type of cancer are they?
Most likely located in head and body, commonly exocrine and Adenocarcinoma
What are the 1) Tumour markers and 2) Genes associated with Pancreatic cancer?
1) CA19-9
2) BRCA2, PALB2
What is Grey Turner’s sign and Cullen’s sign? What do they suggest?
Grey Turner’s: Bruising in flank
Cullen’s Bruising in Umbillicus
Sign of Pancreatic Necrosis / Retroperitoneal Haemorrhage
What is Trousseau’s sign?
Migratory thrombophlebitis -> Palpable nodule under skin
Sign of Pancreatic (and lung, gastric) cancer
What is Courvieoser’s Law?
Palpably enlarged gallbladder which is nontender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones.
What is the first-line imaging investigation for Pancreatic cancer?
Endoscopic ultrasound (EUS)
What are the surgical options for patients with Pancreatic Cancer?
- Whipples procedure (Pancreatoduodenectomy)
- Pancreatectomy
- ERCP Stenting
What are the seven types of Neuroendocrine cells in the Pancreas and what hormones do they secrete? What are the respective PanNETs called (minus enterochromaffin cells)
Alpha cells - glucagon (glucagonoma)
Beta cells - insulin (insulinoma)
Delta cells - somatostatin (somatostatinoma)
Gamma cells - PP (PPoma)
G1 cells - gastrin (gastrinoma)
D cells - VIP (VIPoma)
Enterochromaffin cells - serotonin
What signs would an Insulinoma and a Glucagonoma cause?
Insulinoma - Hypoglycaemia
Glucagonoma - Hyperglycaemia (causing DM)
What signs would Gastrinomas cause?
Zollinger-Ellison syndrome
What signs would VIPomas cause?
WDHA: Watery diarrhoea, hypokalaemia, achlorhydria
Signs and Symptoms of Pancreatic Cancer?
Painless jaundice
Pale stools
Dark urine
Pruritus
Upper abdominal/back pain
UWL
Epigastric palpable mass
N+V
New diabetes/worsening T2DM
What condition should you want to rule out if a patient presents with worsening glycaemic control of T2DM despite intervention/lifestyle measures, or a new onset diabetes?
Pancreatic cancer - it causes diabetes to worsen or happen
Where does pancreatic cancer tend to spread?
Liver (most common)
Peritoneum
Lungs
Bones
Where does pancreatic cancer tend to form?
What is the most common type of pancreatic cancer?
Head of pancreas
Adenocarcinomas
Investigations for pancreatic cancer?
CA19-9 levels - elevated
Endoscopic ultrasound (EUS) to detect tumours
CT abdomen/pelvis to determine surgical resectability and for staging
MRCP to assess biliary system and obstruction
ERCP to insert stent and relieve obstruction and take a biopsy
Referral criteria for pancreatic cancer?
> 40yo + jaundice →2 week wait referral
60 yo + weight loss + another symptom of Pancreatic ca → refer for direct access CT
This is only time where GPs can directly refer patients for CT
