Pancreatic Tumours

Pancreatic Tumours

Symptoms

·        Weight loss, anorexia, lethargy

·        Pain

·        Jaundice (70%)

·        Pruritis (itching)

·        Diabetes mellitus

Investigations

·        FBC: anaemia, sepsis

·        LFT: to confirm obstructive jaundice

·        Ultrasound

·        ERCP or CT

Differential

·        Obstructive jaundice

·        Hepatic jaundice

·        Cachexia: gastric, colorectal or ovarian cancer

·        Other pancreatic disease

Types

·        Pseudocysts (don‟t have epithelial lining so not a true cyst – not neoplastic):

o  Congenital (rare) or acquired

o  Solitary cyst 5 – 10 cm diameter, contains serous, turbid fluid

o  Associated with pancreatitis

·        Benign tumours: rare.  Serous cystadenoma (elderly women), solid cystic tumour (young women)

·        Carcinoma of the pancreas

o  Epidemiology:

§  5% of cancer deaths

§  Usually fatal, 90% die within one year, 5 year survival 1 – 2%

§  Associated with smoking, fatty diet, chemical carcinogens

§  M > F, B > W, 60+

o  Presentation: 

§  Often perineural invasion (travels along nerves) ® difficult pain

§  Affecting head: obstructive jaundice

§  Affecting tail: weight loss, liver metastases 

o   Macroscopic appearance: 60% head (most pancreatic tissue is there). Grey-white tumour with infiltrative margins. Extends to duodenum, liver, nodes, etc

o   Microscopic appearance: 90% adenocarcinoma, 10% adenosquamous.  Other rare types

o   Treatment: palliative.  Stenting or ERCP for duct compression

o   If resection possible:

§  For body/tail: distal pancreatectomy – usually need to remove spleen as well

§  For head: pancreaticoduodenectomy (Whipple operation)

·        Other tumours: benign or malignant endocrine tumours (insulinoma, gastrinoma)