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Pancreatic and Biliary Tumour - Coggle Diagram
Pancreatic and Biliary Tumour
General Approach to Cancer
Diagnostic
Bilirubin, LFTs, lipase, CBC renal function, imaging studies
GI Endoscopy: ERCP, Endoscopic Ultrasound
Pathology
Normal
Islets of Langerhans
Acini
Pancreatic Ducts
Pancreatic Adenocarcinoma
Characteristics
70% in pancreatic Head with obstructive jaundice, 20% in pancreas tail
95% of malignant pancreatic neoplasms are exocrine
Associated with desmoplastic reaction
Treatment
Tumor resectability
Not curative if tumor: extends to adjacent structures, encases large blood vessels, metastises to the liver and peritoneum
Imaging
Transabdominal US is limited (image is hypoechoic, dilated bile ducts, enlarged lymph nodes, liver lesions), MRI and CT have better assessment of tumour (lesion is hypodense, dilated ducts (double duct sign)), ERCP
Pathology
Molecular Alterations
Mutation of K-Ras and inactivation of tumor suppressor genes
Signs and Symptoms
ASthenia, Weight loss, anorexia, abdominal pain, dark urine, jaundice, hepatomegaly, steatorrhea
Head tumors (more often present with jauncdice, steatorrhea, and weight loss)
Biliary Tract and Gall Bladder Cancers
Gall Bladder Cancers
Clinical Presentation
Jaundice, Hepatomegaly, palpable distended gallbladder, palpable abdominal mass, lymphadenopathy, weight loss, progressive weakness
Risk Factors
Primary Sclerosing Cholangitis, Liver Fluke infection, congenital cystic dilation of intrahepatic biliary ducts, gallstones, smoking
Female (More gallstones in women), obesity, GB polyps, Porcelain GB), >50 years of age
Intrahepatic and Extrahepatic are cholangiocarcinoma
Radiology
Dilated bile ducts on US
CT Showing (can show, encasement of blood vessels, and invasion of liver)
Dilated bile ducts
MRCP: Stricture of Bile duct, dilatation of intrahepatic bile ducts
MRI: Shows metastasis to lymph nodes, encasement of portal vein, hepatic artery
Dilated Ducts
Pathology
Biliary Intraeptihelial Neoplasia
1
2
3
Treatment
Stage 0-1: Laparoscopic cholecytectomy
Stage 2,3,4: Radical cholecystectomy
Pancreatobiliary cancer treatment: Whipple procedure
Non-Resectable: Radiation, Chemotherapy
Palliation: Obstruction (biliary/luminal), Pain (Narcotics, Celiac-axis blocks)
Biliary Tract Cancers
Risk Factors
Adenomas, AIDS
Presentation
Jaundice, Pain, Fatigue, Malaise, weight loss in advanced disease
Occasionally: Cholecystitis, cholangitis, pancreatitis, gastric outlet obstruction, diabetes, steatorrhea
Investigations
Cholestasis (Increase ALP, GGT, Bilirubin)
Prolonged Obstruction (deficiency in fat-sopluble vitamines/increase in INR)
Diabetes
CA19-9
Imaging (Abdominal US, CT, MRCP, ERCP, EUS, PET)
