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Flashcards in Pancreatic Cancer Deck (111)
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1

What will pancreatic cancer typically refer to?

Ductal carcinoma of the pancreas

2

What % of primary pancreatic malignancies are ductal carcinoma of the pancreas?

Up to 90%

3

What are the remaining 10% of primary pancreatic malignancies?

Exocrine tumours
Endocrine tumours

4

Give an example of an exocrine tumour of the pancreas

Pancreatic cystic carcinoma

5

Give an example of an endocrine tumour of the pancreas?

Tumour derived from islet cells of pancreas

6

How common is pancreatic cancer compared to other cancers?

10th most common cancer in UK

7

How deadly is pancreatic cancer compared to other cancers?

4th most common cause of cancer death in UK

8

What age group does pancreatic cancer occur in?

Rare under 40 years of age, 80% cases occur between 60-80 years

9

Why does pancreatic cancer have a high mortality?

It is rarely diagnosed early enough for curative treatment

10

How does the mortality of rarer types of pancreatic tumours differ from that of ductal carcinoma?

They often have a much better prognosis

11

What does direct invasion of pancreatic ductal carcinoma typically involve?

Spleen
Transverse colon
Adrenal glands

12

What does the lymphatic metastasis of pancreatic ductal carcinomas typically involve?

Regional lymph nodes, liver, lungs, and peritoneum

13

Is metastasis common at the time of diagnosis of pancreatic ductal carcinoma?

Yes

14

What are the risk factors for the development of carcinoma of the pancreas?

Smoking
Chronic pancreatitis
Recent onset of diabetes mellitus
Late onset diabetes

15

What % of people with pancreatic cancer have a family history of the disease?

7%

16

By how much does a diagnosis of diabetes after 50 increase the risk of developing pancreatic carcinoma in the next 3 years?

8x

17

What % of cases of pancreatic carcinoma are unresectable at diagnosis?

80%

18

Why is pancreatic cancer often diagnosed late?

Due to the late and often vague and non-specific nature of its presentation

19

What do the specific clinical features of pancreatic carcinoma depend on?

The site of the tumour

20

How do cancers affecting the head of the pancreas typically present?

Obstructive jaundice
Abdominal pain, radiating to the back
Weight loss

21

Why do cancers affecting the head of the pancreas cause obstructive jaundice?

Due to compression of the common bile duct

22

What % of cases of cancer affecting the head of the pancreas have obstructive jaundice at the time of diagnosis?

90%

23

Why do cancers affecting the head of the pancreas cause abdominal pain radiating to the back?

Due to invasion of the coeliac plexus, or secondary to pancreatitis

24

Why do cancers affecting the head of the pancreas cause weight loss?

Due to the metabolic effects of the cancer, or secondary to exocrine dysfunction

25

What are the less common presentations of pancreatic cancer?

Acute pancreatitis
Thrombophlebitis migrans

26

What is thrombophlebitis migrans?

A recurrent migratory superficial thrombophlebitis

27

What causes thrombophlebitis migrans in pancreatic cancer?

A paraneoplastic hypercoagulable state

28

What is the problem with the diagnosis of tumours of the tail of the pancreas?

They have an insidious course, and are generally not symptomatic until a late stage

29

What may be found on examination in pancreatic cancer?

Patient may appear cachetic, malnourished, and jaundiced
On palpation, and abdominal mass in the epigastric region may be felt, as well as enlarged gallbladder (as per Courvoisier's Law)

30

What does Courvoisier's law state?

That in the presence of jaundice and an enlarged/palpable gallbladder, malignancy of the biliary tree or pancreas should be strongly suspected, as the cause is unlikely to be gallstones