Summary
Highlights
Introduction to Pancreatic Cancer00:00:12
Pancreatic cancer is often diagnosed late and has a poor prognosis. Most are adenocarcinomas and occur in the head of the pancreas, leading to obstructive jaundice. It tends to spread early, particularly to the liver.
Presentation of Pancreatic Cancer00:01:29
A key presenting feature is painless obstructive jaundice, causing yellow skin and sclera, pale stools, dark urine, and itching. Other vague symptoms include epigastric/back pain, weight loss, a palpable mass, change in bowel habit, nausea, vomiting, or new-onset/worsening diabetes.
Referral Guidelines00:03:12
Nice guidelines suggest referral for suspected pancreatic cancer: patients over 40 with jaundice require a two-week wait referral. Patients over 60 with weight loss plus other symptoms (diarrhea, back pain, abdominal pain, nausea, vomiting, constipation, or new diabetes) should have a direct access CT of the abdomen.
Named Signs00:04:39
Courvoisier's Law states a palpable gallbladder with jaundice suggests malignancy, not gallstones. Trousseau's Sign of Malignancy refers to migratory thrombophlebitis, particularly in pancreatic adenocarcinoma.
Investigations for Pancreatic Cancer00:05:28
Diagnosis relies on imaging (CT scan) and histology from a biopsy. A staging CT scan of the thorax, abdomen, and pelvis is done to check for metastases. CA19-9 is a tumor marker, but it's not specific. MRCP is used to assess the biliary system, and ERCP can relieve obstruction and obtain biopsies.
Management of Pancreatic Cancer00:07:17
Management is decided at a hepatobiliary multidisciplinary team meeting. Surgery to remove the tumor is considered for small, isolated tumors in the head of the pancreas (about 10% of cases). Surgical options include total pancreatectomy, distal pancreatectomy, pylorus-preserving pancreaticoduodenectomy (modified Whipple's), or radical pancreaticoduodenectomy (Whipple's).
Palliative Treatment00:08:32
In most cases, curative surgery isn't possible. Palliative treatment includes stents for biliary obstruction, surgery to bypass obstruction, and palliative chemotherapy or radiotherapy to improve symptoms and extend life. End-of-life care focuses on symptom control.
Whipple's Procedure00:09:05
A Whipple's procedure, or pancreaticoduodenectomy, removes a non-spread tumor in the head of the pancreas. It's a major operation involving removal of the head of the pancreas, pylorus of the stomach, duodenum, gallbladder, bile duct, and lymph nodes. A modified Whipple's procedure preserves the pylorus of the stomach.