Pancreatic Neoplasia
SUMMARY
Symptoms
Head of pancreas (70%)
Body/tail of pancrease (30%)
Risk Factors
Signs
Investigations
Blood: CA19-9 (most useful marker), LFT (hi ALP and bilirubin)
Imaging: Contrast CT, US, ERCP, MRI, MRCP
Others: biopsy
Management
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Epidemiology
Clinical Features
Symptoms
Source
Dr Ray Wilson 2014
Toronto Notes 2012
Symptoms
Head of pancreas (70%)
- Weight loss
- Obstructive jaundice
- vague constant mid-epigastric pain (worse @ night, radiate to back)
Body/tail of pancrease (30%)
- vague mid-epigastric pain
- Weight loss
- sudden onset diabetes
Risk Factors
- Heavy alcohol usage
- Age
- Smoking
- Obesity
- Chronic pancreatitis
Signs
- Palpable mass
- Courvoisier's sign (palpable, non tender distended GB due CBD obstruction)
Investigations
Blood: CA19-9 (most useful marker), LFT (hi ALP and bilirubin)
Imaging: Contrast CT, US, ERCP, MRI, MRCP
Others: biopsy
Management
- Resection (20%) - Whipple procedure
- Borderline resectable --> neoadjuvant therapy then resect
- Non resectable: palliative --> analgesia
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Epidemiology
- 80% ductal adenocarcinoma
- M>F 1.3:1
- Average age 50-70
Clinical Features
Symptoms
- Pain
- Weight loss
- Watery diarrhoea (VIPoma)
Source
Dr Ray Wilson 2014
Toronto Notes 2012