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