• Pancreatic Cancer

    by  • 27/05/2013 • Oncology

     

    1. Major source of mortality in developed world.
    2. Incidence is 9/100,000 and rising
    3. More common in men of African Caribbean descent.
    4. RFs: smoking, high meat/fat diet, old age
    5. Histopathology: most primary malignant tumours of pancreas are adenocarcinoma.
    6. 60% located in head of pancreas (p/c = obstructive jaundice), 25% in body (p/c = pain as infiltrates coeliac nerves, diabetes due to loss of islet cells, and malabsorption due to exocrine deficiency) and 15% in tail of pancreas (p/c = liver mets and anorexia/fatigue)
    7. Clinical features:
      1. o Later on, weight loss, abdo pain, DM, vomiting (from duodenal onstruction), malignant ascites
    8. Ix:
      1. o ERCP: first line Ix for painless obstructive jaundice. Allows for placement of endobiliary stent if bile duct stricture is found
      2. o Abdo CT: determine stages of tumour and whether curative resection is feasible
    9. Mx:
      1. o Often too far advanced at time of presentation and there is no possibility of cure
      2. o Overall, 90% of patients with carcinoma of pancreas are dead within 1st year
      3. o ERCP/stenting: can relieve biliary obstruction
      4. o Surgery: pancreatico-duodenectomy (Whipple’s procedure) offers possibility of a surgical cure. Surgery may also be beneficial in patients with advanced disease in providing biliary and gastroduodenal bypass
      5. o Palliative: pain control (opiates) 
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