Pathology: Can be an exocrine tumour (adenocarcinoma) or endocrine (e.g. Insulinoma, VIPoma, gastrinoma)
Aetiology: Exocrine tumours more common in patients with chronic pancreatitis and smokers
Symptoms: Abdominal Pain, weight loss and anorexia
Signs: Painless jaundice, steatorrhoea, palpable gallbladder, ascites
Investigations: Bloods: LFTs show a raised Bilirubin and ALP
Tumour Markers: Raised CA 19-9
Imaging: Ultrasound Abdomen shows a dilated biliary tree and pancreatic mass.
CT Abdomen shows a pancreatic mass,
Treatment: Medical: If unresectable, treatment is chemotherapy
Surgical: If resectable, usually treated with Whipple’s pancreatoduodenectomy
Complications: Pancreatic leaks, fistula, chronic pain
Prognosis: Often diagnosed late so prognosis is poor.
Median survival with advanced disease is 8 to 12 months and metastatic disease is 3
to 6 months
Pathology: Chronic inflammation of the pancreas resulting in disruption of pancreatic architecture, this causes impaired endocrine and exocrine function
Aetiology: Alcohol excess is commonest, other causes are genetic, SLE, autoimmune, gallstones and idiopathic
Symptoms: Epigastric pain, radiating to the back, steatorrhoea, fat malabsorption, diarrhoea and diabetes
Signs: Epigastric tenderness
Investigations: Bloods: FBC, U&E, LFTs, Glucose, Calcium Profile, Faecal Elastase - reduced
Imaging: Abdominal X-ray shows calcification of the pancreas
CT Abdomen shows calcification of the pancreas and possible pseudocysts
Treatment: Medical: Analgesia for chronic pain, pancreatic enzyme supplements with meals for
exocrine function and insulin if patient has diabetes
Surgical: Coeliac Plexus block for analgesia and pancreaticojejunostomy
Complications: Pancreatic carcinoma, fat soluble vitamin deficiency, pseudocyst formation, gastric
varices, Type 1 diabetes, aneurysm, ascites, biliary obstruction
Prognosis Good prognosis with adequate management. Overall survival is 70% at 10 years.
