Ductal adenocarcinoma
- Most common pancreatic cancer - usually in head of pancreas
- ↑ risk with chronic pancreatitis, DM, alcohol
- Hereditary with Lynch syndrome, FAMMM (p16), Her-2, BRCA1/2, Von Hippel-Lindau, SPINK1, Peutz-Jeghers
Carcinoma
- Almost universally fatal
- Cancers in head can invade common bile duct and pancreatic duct + surrounding structures
- Cancers in the body or tail invade stomach, left colon, spleen and left adrenal
Red flags
- Painless obstructive Jaundice - tumour compresses on bile duct
- Steatorrhea
- New onset diabetes or worsening of gllycaemic control
Investigations
CA19-9 - tumour marker, also raised in cholangiocarcinoma
CT pancreas - only time a GP can directly refer for a CT
MCRP & ECRP - assess the biliary system and put a stent in and biopsy respectively