Pancreatic Cancer

Question 1

Most common type of pancreatic cancer

Answer 1

Ductal adenocarcinoma in head of pancreas

Question 2

Why is pancreatic cancer prognosis poor

Answer 2

• late diagnosis
• early matastases

Question 3

Where does pancreatic cancer metastase to?

Answer 3

Liver
Peritoneum
Lungs
Bone

Question 4

Risk factors of pancreatic cancer

Answer 4

• smoking
• chronic pancreatitis
• inheriated mutations in BRCA1, BRCA2
• male
• increasing age

Question 5

Presentation of pancreatic cancer

Answer 5

• painless obstructive jaundice: jaundice, pale stools, dark urine, generalised itching
• abdominal mass
• unexplained weight loss
• new onset diabetes or worsening DMT2

Question 6

What is Courvoisier’s law?

Answer 6

Palpable gallbladder + jaundice is most commonly pancreatic cancer or cholangiocarcinomas

Question 7

What is Trousseau’s sing of malignancy?

Answer 7

Migratory thrombophlebitis is a sign of malignancy (particularly pancreatic adenocarcinoma)
inflamed blood vessels + clot in reoccurring in different locations over time

Question 8

Investigations of pancreatic cancer

Answer 8

• abdominal USS initial
• staging CT thorax, abdo, pelvis
• CA 19-9: tumour marker
• MRCP
• biopsy: percutaneous under USS or CT guidance or during ERCP

Question 9

Tumour marker in pancreatic cancer

Answer 9

CA 19-9

Question 10

Management of pancreatic cancer

Answer 10

• total or distal pancreatectomy
• Whipple procedure (radical pancreaticoduodenectomy)
• modified whipples procedure (pylorus preserving pancreaticoduodenectomy)
• stent via ERCP
• palliative chemotherapy or radiotherapy

Question 11

Outline whipple procedure

Answer 11

• Radical pancreaticoduodenectomy
• surgical operation to remove pancreastic tumour localised to the head
• removal of head of pancreas, pylorus of stomach, duodenum, gallbladder, bile ducts, lymph nodes

Question 12

Outline modified whipple’s procedue

Answer 12

Pylorus preserving pancreaticoduodenectomy
Leaving pylorus in place