Pancreatic cancer

Question 1

Define

Answer 1

malignancy arising from the exocrine or endocrine tissues of the pancreas

Question 2

Causes/ risk factors

Answer 2

UNKNOWN

5-10% are hereditary (e.g. MEN, HNPCC, FAP, Von-Hippel Lindau syndrome)

Risk Factors

• Age
• Smoking
• Diabetes mellitus
• Chronic pancreatitis
• Dietary (low intake of fresh fruit and vegetables)

Question 3

Epidemiology

Answer 3

Increasing incidence

2 x more common in MALES

Peak age: 60-80 yrs

Question 4

Symptoms

Answer 4

Initial symptoms are often NON-SPECIFIC

Anorexia

Malaise

Nausea

Epigastric pain

Weight loss

Diabetes mellitus

Jaundice

Question 5

Signs

Answer 5

Weight loss

Epigastric tenderness or mass

Jaundice and a palpable gallbladder (Courvoisier’s law - a palpable gallbladder with painless jaundice is unlikely to be due to gallstones)

If metastatic spread –> hepatomegaly

Trousseau’s Sign of Malignancy - superficial thrombophlebitis

Question 6

Investigations

Answer 6

Bloods

• CA 19-9
• CEA is also elevated
• Obstructive jaundice features:
  
  • High bilirubin
  • High ALP
  • Deranged clotting

Imaging

• Ultrasound
• CT with/without guided biopsy
• MRI/MRCP
• ERCP - may allow biopsy, bile cyto