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Pancreatic Adenocarcinoma (Risk Factors (Diabetes, Chronic pancreatitis,…
Pancreatic Adenocarcinoma
Epidemiology
More common in MALES than female
Typical patient is male about 60yrs
UK incidence is rising
Rare in those younger than 40yrs
99% occurs in the exocrine component
Majority are adenocarcinoma and the large majority are of ductal origin
Risk Factors
Diabetes
Chronic pancreatitis
Excessive use of aspirin
Genetic mutation predisposing to pancreatic cancer - presence of PRSS-1
Excessive intake of alcohol or coffee
Family history
Smoking is associated with a two-fold risk increase
Pathophysiology
60% arise in the pancreatic head
25% arise in the body
Most ductal adenocarcinomas metastasise EARLY and thus present late
15% in the tail
Originates in the ductal epithelium and evolves from pre-malignant lesions to full-invasive cancer
Clinical Presentation
Diabetes
Acute pancreatitis
Weight loss
Head of pancreas - PAINLESS obstructive jaundice (pale stools and dark urine)
Anorexia
Body & tail of pancreas - epigastric pain that radiates to the back and is relieved by sitting forward
Differential Diagnosis
However, many present with minor symptoms such as pain, changing bowel habit and weight loss
Abdominal CT should be done if pancreatic cancer is suspected
Diagnosis should NOT BE DIFFICULT in the presence of PAINLESS JAUNDICE or epigastric pain radiating into the back with progressive weight loss
IgG4-relared autoimmune pancreatitis
Diagnosis
Cholestatic jaundice is non-specific but helps assess prognosis
Transabdominal ultrasound and CT to find pancreatic mass +/- dilated biliary tree
Patients with pancreatic adenocarcinoma frequently present quite late stage that often cannot be cured
They can guide biopsy and help with staging prior to surgery
Treatment
Surgery
High post-op morbidity
Post-op chemotherapy delays disease progression
Consider pancreato-duodectomy if fit and no metastases
Palliative therapy
Opiates for pain
Nutritional supplementation
Palliation of jaundice using stenting
5 year survival is 3%