Red PTS Flashcards
(40 cards)
What is pancreatic cancer?
primary pancreatic ductal adenocarcinoma, which accounts for >85% of all pancreatic neoplasms. These adenocarcinomas usually affect the head of the pancreas, but sometimes the body and tail. Some are multifocal.
What are the risk factors for pancreatic cancer?
Old age (60+), smoking, obesity, T2DM, FHx, Chronic Pancreatitis
What is the pathophysiology of pancreatic cancer?
Adenocarcinoma typically in the head of the pancreas and can compress bile ducts
Pancreatic cancer develops from pre-invasive pancreatic intraepithelial neoplasia, which can eventually become an invasive ductal adenocarcinoma.
What is the presentation for pancreatic cancer?
- Obstructive/Painless Jaundice,
- pale stools
- dark urine
- generalized itching (pruritus)
- weight loss
- worsening of T2DM (or new onset)
- Yellow skin
What is Courvoisier’s Sign?
A type of presentation of Pancreatic cancer
palpable gallbladder + jaundice
Can get epigastric pain that radiates to back (body and tail)
What is the gold standard investigation for pancreatic cancer?
CT of pancreas (identifies mass and helps with staging of cancer)
What other investigations can be done for pancreatic cancer?
Abdominal ultrasound
Tumour marker – Ca19-9 not diagnostic but helps with monitoring progression
Staging CT scan
MRCP - assess billiary system
ERCP - used to put a stent in and relieve obstruction - also obtain biopsy from the tumour
LFTs
What is the treatment for pancreatic cancer?
Surgery to remove tumour – Whipple procedure (pancreaticoduodenectomy + others)
Chemo/Radiotherapy
Complications for pancreatic cancer?
- Venous Thromboembolism (VTE):pancreatic adenocarcinoma is thrombogenic and patients are at increased risk of DVT and PE
- New-onset diabetes mellitus:reduced endocrine function due to cancer growth, as well as surgical resection
- Cholangitis:obstruction of biliary drainage due to a head of pancreas cancer predisposes to biliary tree infection
What can happen in pancreatic cancer?
Once a tumour in the head of the pancreas grows large enough it can compress the bile ducts, resulting in obstructive jaundice.
Average survival for pancreatic cancer?
6 months with advanced disease
Referral for pancreatic cancer
Over 40 with jaundice – referred on a 2 week wait referral
Over 60 with weight loss plus an additional symptom (see below) – referred for a direct access CT abdomen
Different surgeries for pancreatic cancer
Total pancreatectomy
Distal pancreatectomy
Pylorus-preserving pancreaticoduodenectomy (PPPD) (modified Whipple procedure)
Radical pancreaticoduodenectomy (Whipple procedure)
What is the Whipple procedure?
surgical operation to remove a tumour of the head of the pancreas that has not spread. A Whipple procedure is a massive operation so patients need to be in good baseline health. It involves the removal of the:
Head of the pancreas
Pylorus of the stomach
Duodenum
Gallbladder
Bile duct
Relevant lymph nodes
2 types of primary liver cancer:
Primary liver cancer is cancer that originates in the liver.
hepatocellular carcinoma (80%) and cholangiocarcinoma (20%).
Secondary liver cancer
originates outside the liver and metastasises to the liver. Metastasis to the liver can occur in almost any cancer that spreads. There is a poor prognosis of any cancer with liver metastasis.
Risk factors for HCC
Liver cirrhosis due to:
Viral hepatitis (B and C)
Alcohol
Non alcoholic fatty liver disease
Other chronic liver disease
What is cholangiocarcinoma assosciated with?
primary sclerosing cholangitis. However, only 10% of patients with cholangiocarcinoma had primary sclerosing cholangitis
Cholangiocarcinoma usually presents in patients > 50 years old unless related to primary sclerosing cholangitis.
Who are most likely to get hepatocellular carcinoma?
Males (90%)
Pathophysiology of hepatocellular carcinoma
Arise from liver parenchyma
It can metastasise via the hepatic or portal veins to the lymph nodes, bones and lungs
Presentation of hepatocellular carcinoma
Liver: Jaundice, Ascites, HE, Pruritus
Non-specific symptoms: Weight Loss, Fatigue, Weakness, N+V
Diagnosis and investigations for HCC?
1st Line: Abdominal Ultrasound
CT to confirm (GOLD STANDARD)
Serum Alpha-Fetoprotein (AFP) = tumour marker for HCC
CT and MRI
HCC treatment
Poor prognosis unless diagnosed early
Resection of early disease in resectable area of liver can be curative
Liver transplant when HCC is isolated to liver can be curative
Drugs used in HCC
Several kinase inhibitors:
work by inhibiting the proliferation of cancer cells. Some examples of these are sorafenib, regorafenib and lenvatinib. They can potentially extend life by months.
