Pancreatic Cancer

See Upper Gastrointestinal Malignancies for epidemiology, Whipple resection detail, and palliative management.

Carcinoma of the head of the pancreas

Demographics: more common in men, usually over 60 years of age.

Murtagh’s triad: jaundice + constitutional symptoms (malaise, anorexia, weight loss) + epigastric pain (radiating to back) suggests pancreatic cancer.

History: pain (>75%) in the epigastrium and back; weight loss, malaise, diarrhoea; migratory thrombophlebitis (Trousseau syndrome); palpable, hard, fixed mass; metastases (e.g. left supraclavicular gland of Virchow — Troisier sign). Other features: occult blood in stool, glycosuria.

Examination: obstructive jaundice; enlarged gallbladder (Courvoisier’s sign).

Investigations: CT scan.

Management: urgent referral to an upper GI surgeon.

Intraductal papillary mucinous neoplasm (IPMN)

A premalignant pancreatic cystic lesion, increasingly found incidentally on imaging — pancreatic cystic lesions are present in up to 75% of the general population on some estimates, with prevalence rising with age.

Three morphological subtypes, with different malignancy risk: main-duct, branch-duct, and mixed. Main-duct and mixed IPMN carry much higher malignancy risk than branch-duct IPMN. Overall malignant transformation risk is ~2–2.7%/year.

Management: risk-stratified by “worrisome features” vs “high-risk stigmata” on imaging, which drives the surveillance-vs-resection decision — refer to gastroenterology/upper GI surgery for risk stratification and an ongoing surveillance-imaging plan once an incidental pancreatic cystic lesion is found.