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Pancreatic cancer (Risk factors (Carcinogens, DM, Alcohol, Chronic…
Pancreatic cancer
Risk factors
Carcinogens
DM
Alcohol
Chronic pancreatitis
Smoking
Obesity
Clinical
presentation
Acute pancreatitis
DM
Weight loss
Painless jaundice
(
if head of pancreas)
Anorexia
Epigastric pain
radiating to back
(
body and tail)
Epidemiology
Rare
Increasing incidence
High mortality
Diagnosis
Examination
Abdo exam
Jaundice, adcites, hepatosplenomegaly, mass
Palpable gallbladder (Courvoisier's law)
Investigations
Bloods
LFTs: raised ALP, y-GT
Ca markers: raised CA 19-9
Also FBC, CRP, U+E
bone profile, glucose, lipids
Imaging
USS/CT (staging)
ERCP (locate site)
Biopsy
USS/CT guided
Bedside
Obs (nil)
History
DH
Meds, allergies
FH
Cancers
SH
Living arrangements, social support,
occupation, smoking, alcohol
PMH
Prev cancers, chronic pancreatitis,
other medical conditions
PC/HPC
Painless jaundice, anorexia,
weight loss, malaise, abdo pain
Management
Surgery
Laparoscopy
MOA: laparoscopic excision
Stenting
Indication: palliative
MOA: stent to relieve obstruction
Pancreatoduodenectomy
Indication: resectable
MOA: Whipple's procedure; removal of pancreas
and part of duodenum, form conduit for bile to small intestine
Medical
Analgesia
Indication: pain
Chemotherapy
Indication: adjunctive/neoadjunct to surgery
Conservative
Information, advice, support
MDT appoach (gastro, gen surg, specialist nurse, endocrine,
palliative, dietician, physio/T, counsellors)
Prognosis
Poor
<6m, 5y 3%
Whipple's 5y 5-15%
Pathophysiology
Most in head, some in body, few in tail
Commonest ductal adenocarcinoma,
also rarely insulinomas, gastrinomas,
glucagonomas, somatostatinomas
Definition
Malignant neoplasm of
the pancreas