Pancreatic Neoplasms Flashcards
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
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
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
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
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
