Pancreatic cancer

Pancreatic cancer is often diagnosed late as it tends to present in a non-specific way. Over 80% of pancreatic tumours are adenocarcinomas which typically occur at the head of the pancreas.

Associations

• increasing age
• smoking
• diabetes
• chronic pancreatitis (alcohol does not appear an independent risk factor though)
• hereditary non-polyposis colorectal carcinoma
• multiple endocrine neoplasia
• BRCA2 gene
• KRAS gene mutation

Features

• classically painless jaundice
  • pale stools, dark urine, and pruritus
  • cholestatic liver function tests
• the following abdominal masses may be found (in decreasing order of frequency)
  • hepatomegaly: due to metastases
  • gallbladder: Courvoisier's law states that in the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones
  • epigastric mass: from the primary tumour
• many patients present in a non-specific way with anorexia, weight loss etc
• epigastric pain
  • whilst 'painless jaundice' is the classic presentation many patients present with pain
  • may radiate to the back
  • often worse when lying flat or after eating
• loss of exocrine function (e.g. steatorrhoea)
• loss of endocrine function (e.g. diabetes mellitus)
• migratory thrombophlebitis (Trousseau's syndrome) is more common than with other cancers