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Pancreatic Cancer

The most common type of pancreatic cancer is an adenocarcinoma, which typically forms at the head of the pancreas. This mass can cause compression of the bile duct, leading to obstructive jaundice. Risk factors for it include:

  • Smoking, Alcohol, Chronic Pancreatitis, T2DM, Obesity

  • Age, Family hx of pancreatic cancer

  • KRAS2 mutation (95%)

“Diagram showing stage T2 cancer of the pancreas” © Cancer Research UK (Licensed under CC-BY 4.0) https://creativecommons.org/licenses/by/4.0/


The main presenting symptom with this is painless, obstructive jaundice. The key differential to rule out with this is a Cholangiocarcinoma. Other presenting features include:

  • Epigastric pain

  • New-onset Diabetes (or worsening of it)

  • Steatorrhoea

  • Unintentional weight loss

  • Courvoisier’s Law - Palpable gallbladder + jaundice is unlikely to be due to gallstones, and is usually due to a cholangiocarcinoma or pancreatic cancer.


The paraneoplastic syndrome that occurs here is Trousseau’s. This is migratory thrombophlebitis that affects the extremities of the body.


N.B. Patients often presents very late due to its non-specific symptoms of malaise, weight loss, and nausea.


Investigations:

  • Abdomen USS - Good at detecting tumours at head, but not body/tail so a -ve result doesn’t rule out cancer

  • CT

  • CA19-9

  • LFTs

  • MRCP/ERCP


Management:

  • Palliative - stenting, chemoradiotherapy

  • Curative - Whipples procedure (pancreaticoduodenectomy)

“Diagram showing how the pancreas and bowel is joined back together after a Whipple's operation” © Cancer Research UK (Licensed under CC-BY 4.0) https://creativecommons.org/licenses/by/4.0/


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