Pancreatic cancer: features and investigation

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

Features

• classically painless jaundice
• however, patients typically present in a non-specific way with anorexia, weight loss, epigastric pain
• loss of exocrine function (e.g. steatorrhoea)
• atypical back pain is often seen
• migratory thrombophlebitis (Trousseau sign) is more common than with other cancers

Investigation

• ultrasound has a sensitivity of around 60-90%
• high resolution CT scanning is the investigation of choice if the diagnosis is suspected

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