Pancreatic Cancer

Question 1

What are the types of cancers you can get in the pancreas

Answer 1

Ductal carcinomas
Exocrine tumor
Endocrine tumor

Question 2

What is the most common type of pancreatic cancer

Answer 2

Ductal carcinoma - 90%

Question 3

Where does the cancer commonly spread to

Answer 3

local: structures such as the spleen, transverse colo, adrenal glands, local lymph nodes
Distant: liver, lungs

It is common to have metastatic disease at diagnosis

Question 4

What are the risk factors for pancreatic cancer

Answer 4

Smoking
Chronic pancreatitis
FH
Diabetes mellitus

Question 5

What is Courvoisiers law

Answer 5

Courvoisier’s law states that in the presence of jaundice and an enlarged/palpable gallbladder, malignancy of the biliary tree or pancreas should be strongly suspected as the cause is unlikely to be gallstones.

Question 6

How does a patient with pancreatic cancer of the head present with

Answer 6

Obstructive jaundice ( compression of CBD)
Abdominal pain radiating to back ( due to coeliac trunk invasion ) 
Weight loss ( metabolic effects of the cancer )

Question 7

What are the examination findings with pancreatic carcinoma

Answer 7

Cachetic, malnourished, jaundiced, enlarged gall bladder ( in line with courvoisers law)

Question 8

What are the differential diagnosis of epigastric pain and obstructive jaundice

Answer 8

Epi pain - AAA, gastritis, GORD, gall stones, acute pancreatitis
Obstructive jaundice - gall stones, cholangio-carcinoma

Question 9

Which lab tests would you order pancreatic cancer

Answer 9

FBC
LFT
CA19-9 ( high sensitivity and specificity for pancreatic cancer but more used for assessing treatment response)

Question 10

Which imaging modalities would you use to investigate pancreatic cancer

Answer 10

USS abdo
CT pancreas
CT chest -abdo-pelvis for staging along with PET scan
EUS and can do FNA to send to biopsy

Question 11

How would you manage pancreatic carcinoma

Answer 11

• If cancer at the head of pancreas => Whipple procedure

- If pancreas cancer in the distal pancreas => distal pancreatectomy

Question 12

What are the contradiction for surgery

Answer 12

Distal mets to the liver/lung

Question 13

Which chemotherapy agent is used for the treatment of pancreatitis

Answer 13

5 - Fluoro-uracil

Question 14

What palliative care options are available

Answer 14

This option is for people who are not suitable for surgery therefore symptomatic relief needed:
ERCP to help with obstructive jaundice
CREON - pancreatic enzymes

Question 15

What is the prognosis of pancreatic cancer

Answer 15

5% have less than 5 year survival rate

Question 16

Give 5 examples of endocrine pancreatic tumors

Answer 16

Gastrinoma 
Insulinoma 
Somatostatinoma 
VIPoma 
Glucagonoma

Question 17

Which syndrome are endocrine pancreatic tumors associated with

Answer 17

MEN1 - multiple endocrine neoplasia 1

Comprises of hyperparathyroidism, endocrine pancreatic tumours and pituatary tumours ( commonly prolactinomas )

Question 18

How would you investigate pancreatic endocrine tumours

Answer 18

CT
MRI
EUS

Question 19

How would you manage endocrine pancreatic tumours

Answer 19

Surgical resection