Pancreatic Tumours

Aetiology

Risk factors

  • Smoking
  • Charred meat
  • Obesity
  • Diabetes

Pathophysiology

Exocrine tumours

  • Adenocarcinoma - 95% of pancreatic tumours

Endocrine tumours

  • Gastrinoma - produces gastrin which increases stomach acid → peptic ulcer disease (Zollinger-Ellison syndrome)
  • Insulinoma - produces insulin which encourages sugar uptake and storage → hypoglycaemia
  • Glucagonoma - produces glucagon which increases serum blood sugars → hyperglycaemia

Clinical presentation

Symptoms

  • Steatorrhoea
  • Dark urine
  • Weight loss
  • Back pain

Signs

  • Painless jaundice
  • Palpable gallbladder

Investigations

Blood tests

  • Obstructive jaundice - raised bilirubin and ALP, ALT and AST may also be raised
  • Hyper/hypoglycaemia if endocrine tumour

Imaging

  • USS
  • Triple phase CT
  • MRI and MRCP

Management

Inoperable cases

  • ERCP or PTC and stent insertion
  • Decompression of obstructed biliary ducts

Operable cases

  • ERCP stent
  • Biopsy (laparoscopy) + staging
  • Surgery - resection (curative), palliative bypass