Pancreatic Neoplasms Flashcards Preview

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Flashcards in Pancreatic Neoplasms Deck (5):
1

What is the main type of pancreatic carcinoma?

The most common type of pancreatic cancer is a Ductal Adenocarcinoma (90%) of the pancreas (Affecting the head of the tail) but the ampulla of Vater can also be affected

2

What will you find on a history taking of Pancreatic Cancer?

Symptoms:
Pancreatic Cancer will present with symptoms very late and so most patients will present with symptoms of a metastasise rather than those of pancreatic cancer
Painless Obstructive Jaundice – If affecting the Head of pancreas
Epigastric Pain (Radiating to back and relieved by sitting forward, felt more at night)
Weight Loss
Anorexia
Diabetes – Recent onset (<1 year)
Hypercalcaemia

Risk Factors:
Smoking
Alcohol
Diabetes
Obesity
Red Meat

3

What will you find on Examination of a patient with Pancreatic Cancer?

End of the bed:
Jaundice
Neck:
Lymphadenopathy – Virchow’s node
Abdomen:
Palpable Gallbladder
Epigastric Mass
Hepatomegaly/Splenomegaly – Metastasise
Ascites

4

What investigations will you order in suspected pancreatic cancer?

Bloods:
FBC – Looking for any signs of infection or anaemia
Amylase – May be raised in some patients
U&E – Looking for any renal metastasise
LFT – Raised ALP and GGT in obstructive jaundice, will also show any metastasise
Calcium – Will be raised
Ca 19-9 can be raised - Good prognostic factor but not specific

Imaging:
US - To look for pancreatic mass, Biliary tree dilation, Hepatic Mass
Abdominal CT scan
Followed By any needed ERCP - can localise site of obstruction

5

What is the treatment of Pancreatic Carcinoma?

Many pancreatic cancers have metastasised at point of presentation so there is a very low survival rate. Refer all patients to the palliative care team.

Curative - Whipple's procedure (Pancreatoduodenectomy) with/without Post-operative chemotherapy

Palliative - Biliary tree stenting to limit jaundice, Lots of Analgesia (Opiates) and Radiotherapy may be helpful