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Pancreatic Cancer

From Mediwikis

Incidence

Majority are over 60 years old and male. Pancreatic cancer is the fifth most common cause of cancer death in the UK.

Causes

It is associated with:

  • Smoking
  • Alcohol excess
  • Diabetes
  • Chronic pancreatis

Clinical Features

  • Painless jaundice (but ~80% are painful[1])
  • Pain can come on later in the disease progression as the cancer grows
  • Weight loss
  • Urticaria & Scratch marks
  • Courvoisier's sign- Palpable gall bladder
  • Rare- Thromboembolism, polyarthritis, skin nodules

Investigations

  • Abdominal Ultrasound scan or CT for mass sizing & location
  • Laparoscopy
  • ERCP- palliative treatment
  • CA19-9 High sensitivity

Management[2]

  • Five year survival is 10-15%
  • MDT meeting to assess whether surgery is suitable (20% of cases)
  • ERCP to treat obstructive jaundice

Complications

Zollinger-Ellison Syndrome

Gastrin-secreting tumour of the pancreas leads to GI ulceration

Clinical Features

  • Diarrhoea + Steatorrhoea
  • Abdominal Pain
  • Nausea
  • Pain between meals
  • Weight loss
  • Anorexia

Clinical Features

  • Secretin Stimulation Test
  • Fasting Gastrin levels
  • GI pH monitoring

Management

  • PPIs + H2 antagonists
  • Octreotide
  • Surgical Management

References

  1. Bond-Smith G, Banga N, Hammond TM, Imber CJ (2012). "Pancreatic adenocarcinoma" (PDF). BMJ (Clinical research ed.) 344: e2476. doi:10.1136/bmj.e2476. PMID 22592847.
  2. http://www.bsg.org.uk/clinical-guidelines/pancreatic/guidelines-for-the-management-of-patients-with-pancreatic-cancer-periampullary-and-ampullary-carcinomas.html