Pancreatic Cancer

Basics

  • 90% are adenocarcinomas of the head of the pancreas
  • Present late as do not cause symptoms until blocking biliary system and causing painless jaundice
  • Typically metastasize early to liver, then to peritoneum, lungs and bones
  • All cases must be discussed at HPB (hepatobiliary) MDT meeting to decide management
  • Peak incidence in 70s and 80s
  • 5 year survival is 25% for early disease
  • Average survival for advanced disease is around 6 months

 

Presentation

  • Non-specific upper abdominal/back pain
  • Painless obstructive jaundice
  • Unintentional weight loss
  • Pale stools (due to lack of bile)
  • Steatorrhoea (greasy stools due to malabsorption due to lack of bile)
  • Dark urine (due to obstructive jaundice)
  • Palpable mass in epigastric region

 

Diagnosis

  • CA19-9 tumour marker (blood test)
  • CT scan (including thorax, abdomen and pelvis for staging)
  • Endoscopic ultrasound with biopsy

 

Courvoisier’s law

  • Painless jaundice plus a non-tender palpable gallbladder is pancreatic cancer until proven otherwise

 

Whipple’s procedure

  • Requires the patient the be in good baseline health
  • For tumour of head of pancreas with no spread
  • Involves removing head of pancreas, gallbladder, duodenum and pylorus
  • Modified Whipple’s involves leaving the pylorus, and has equal success rates to traditional Whipples

 

Other management

  • Distal pancreatectomy for tumour of body/tail of pancreas
  • Adjuvant chemotherapy

 

Late disease management

  • Palliative chemotherapy may be offered if fit to attempt to extend life
  • Palliative stenting of bile ducts to relive obstruction
  • Palliative care
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