Pancreatic Cancer

Question 1

What type of cancer is most commonly associated with pancreatic tumors?

Answer 1

Adenocarcinomas

Over 80% of pancreatic tumors are adenocarcinomas.

Question 2

At which part of the pancreas do most adenocarcinomas occur?

Answer 2

Head of the pancreas

Question 3

List three associations with pancreatic cancer.

Answer 3

• Increasing age
• Smoking
• Diabetes

Question 4

What is Courvoisier’s law related to?

Answer 4

Palpable gallbladder in the presence of painless obstructive jaundice

Courvoisier’s law states that a palpable gallbladder is unlikely to be due to gallstones.

Question 5

What are common symptoms of pancreatic cancer?

Answer 5

• Painless jaundice
• Pale stools
• Dark urine
• Pruritus

Question 6

What percentage of pancreatic cancer patients are suitable for surgery at diagnosis?

Answer 6

Less than 20%

Question 7

What is the investigation of choice if pancreatic cancer is suspected?

Answer 7

High-resolution CT scanning

Question 8

What is the classic presentation of pancreatic cancer?

Answer 8

Painless jaundice

Question 9

Fill in the blank: Migratory thrombophlebitis is also known as _______.

Answer 9

Trousseau’s syndrome

Question 10

What are two potential side effects of a Whipple’s resection?

Answer 10

• Dumping syndrome
• Peptic ulcer disease

Question 11

What imaging sign may indicate pancreatic cancer?

Answer 11

‘Double duct’ sign

The ‘double duct’ sign indicates simultaneous dilatation of the common bile and pancreatic ducts.

Question 12

What may worsen epigastric pain in pancreatic cancer patients?

Answer 12

Lying flat or after eating

Question 13

What is one common non-specific symptom of pancreatic cancer?

Answer 13

Anorexia

Question 14

Which gene is associated with familial pancreatic cancer risk?

Answer 14

BRCA2 gene

Question 15

What type of function loss can occur with pancreatic cancer?

Answer 15

• Exocrine function loss (e.g. steatorrhoea)
• Endocrine function loss (e.g. diabetes mellitus)

Question 16

True or False: Chronic pancreatitis is an independent risk factor for pancreatic cancer.

Answer 16

False

Question 17

What is a common feature of liver function tests in pancreatic cancer?

Answer 17

Cholestatic liver function tests

Question 18

What is the role of ERCP with stenting in pancreatic cancer management?

Answer 18

Palliation

Question 19

What may be found upon examination of a patient with pancreatic cancer?

Answer 19

• Hepatomegaly
• Palpable gallbladder
• Epigastric mass

Question 20

What is the typical sensitivity range of ultrasound in detecting pancreatic cancer?

Answer 20

60-90%

Question 21

What type of pain is often associated with pancreatic cancer?

Answer 21

Epigastric pain

Question 22

What is used to assess in the first 48 hours of patient admitted for acute pancreatitis?

Answer 22

Glasgow imrie score

Question 23

What are the aspects of the Glasgow imrie score?

Answer 23

P - PaO2 (Oxygen levels): PaO2 < 8 kPa (or < 60 mmHg), or requiring oxygen therapy.
A - Age: > 55 years.
N - Neutrophils (White blood cell count): > 15 x 10⁹/L.
C - Calcium: Serum calcium < 2 mmol/L (or < 8 mg/dL).
R - Renal function (Urea): Blood urea nitrogen > 16 mmol/L (or > 45 mg/dL).
E - Enzyme levels (Serum amylase/lipase): Significantly elevated levels of amylase or lipase.
A - Albumin: Serum albumin < 32 g/L.
S - Sugar (Glucose): Blood glucose > 10 mmol/L (or > 180 mg/dL).

Question 24

What is a less used alternative for Glasgow imrie score?

Answer 24

Ranson criteria at admission and after 48 hours
At admission:

Age: > 55 years
White blood cell (WBC) count: > 16,000 cells/mm³
Blood glucose: > 200 mg/dL (or > 11.1 mmol/L)
Serum AST (Aspartate aminotransferase): > 250 U/L
Serum LDH (Lactate dehydrogenase): > 350 U/L

Question 25

What is measured after 48 hours?

Answer 25

Hematocrit decrease: > 10% drop in hematocrit BUN (Blood Urea Nitrogen): > 5 mg/dL increase Serum calcium: < 8 mg/dL Arterial PaO2 (Partial pressure of oxygen): < 60 mmHg Base deficit: > 4 mEq/L (a sign of metabolic acidosis) Fluid sequestration: > 6 liters (the amount of fluid lost due to third spacing)