Hello and welcome to the Zero to Finals podcast.

My name is Tom and in this episode I'm going to be talking to you about pancreatic cancer.

And as always, you can follow along with written notes on this topic at zero definals.com

slash pancreatic cancer or in the general surgery section of the

zero definals surgery book. So let's get straight into it. Pancreatic cancer is often diagnosed late

and has a very poor prognosis. The vast majority are adenocarsinomas and most occur in the

head of the pancreas, as opposed to the tail or

the body. Once a tumour in the head of the pancreas has grown large enough, it can compress

the bile ducts, and this results in obstructive jaundice, which is a key feature of pancreatic

cancer. Pancreatic cancers tend to spread and metastasize early, particularly to the liver

and then to the peritoneum, the lungs and the bones. The average survival when diagnosed with

advanced disease is around six months. If pancreatic cancer is caught early and the cancer is isolated to the pancreas and surgery is possible, the five-year survival is still around 25% or less.

So let's talk about the presentation. Painless, obstructive jaundice is a key presenting feature that should make you immediately consider

pancreatic cancer. The key differential diagnosis to this is colangio-carcinoma. Painless

obstructive jaundice occurs when the tumour at the head of the pancreas compresses the bile

ducts, blocking the flow of bile out of the liver. It presents with yellow skin and yellow

sclera, which is jaundice, pale stools, dark urine and generalised itching. The other

presenting features for pancreatic cancer can be vague, including non-specific upper abdominal or back pain,

unintentional weight loss, a palpable mass in the epigastric region, a change in the

bowel habit, nausea or vomiting, and a new onset of diabetes or a worsening of type 2 diabetes.

A tom tip for you, it's worth noting that a new onset of diabetes or a rapid worsening

of glycemic control in type 2 diabetes can be a sign of pancreatic cancer.

...