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2. The differential diagnosis of a mass lesion in pancreas includes all except:

1. Lymphoma
2. Neuroendocrine tumour
3. Focal chronic pancreatitis
4. Autoimmune pancreatitis
5. None of the above

3. A 65 year old gentleman presented with dull aching upper abdominal pain radiating through to the back and worsened by eating. He had also noticed yellow discoloration of his skin and had lost weight. In his past medical history, he was diagnosed with diabetes mellitus 6 months earlier. A CT scan revealed a localised mass lesion in the head of pancreas with biliary duct dilatation. All the following are true except:

1. CT guided biopsy is needed to confirm the diagnosis
2. There is little evidence of benefit from routine biliary stenting of jaundiced patients before resection.
3. A diagnosis of pancreatic cancer should be considered in unexplained diabetes (no family history, obesity or steroids) in patients over 50 years of age.
4. Gastroduodenal artery encasement is not a contraindication for curative surgery
5. Whipple’s operation is the standard operation for cancer of pancreatic head

Explanation :EUS guided FNA biopsy is used in patients with resectable tumours. This is less likely to cause intraperitoneal spread of the tumor since the biopsy is obtained through the bowel wall rather than percutaneously. Biliary stenting may be helpful if the surgery is delayed for more than 10 days as patients with obstructive jaundice are at risk for associated coagulopathy, malabsorption, and malnutrition.

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MCQ On Pancreatic cancer

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