Examqo › Examqo library › General surgery › Liver, pancreas, biliary and bariatric · IMLE
Pancreatic cancer
Pancreatic cancer usually presents with painless jaundice, weight loss and new-onset diabetes; a pancreas-protocol CT decides whether the tumour is resectable, and resection with adjuvant chemotherapy is the only chance of cure.
Why it matters in the exam
The classic case is an older patient with painless jaundice, itching, dark urine and pale stools, sometimes with an enlarged non-tender gallbladder (Courvoisier's sign). Other questions present new diabetes in a thin older adult, migratory thrombophlebitis (Trousseau) or back pain indicating nerve invasion. The first test is a pancreas-protocol CT; CA 19-9 helps in follow-up but does not make the diagnosis, and it also rises with any biliary obstruction.
The core question is "can it be resected?": a tumour without arterial contact (SMA, coeliac axis, common hepatic artery) and with venous contact of up to 180 degrees is resectable; more contact is borderline, and encasement of the superior mesenteric artery of more than 180 degrees is locally advanced. A tumour of the head is removed by a Whipple procedure, and one in the body and tail by distal pancreatectomy with splenectomy. After surgery adjuvant chemotherapy is given for about six months; in borderline disease chemotherapy is given first. Pre-operative biliary drainage is not routine — only for cholangitis, severe jaundice or when surgery is delayed.
Key points
- Painless jaundice, weight loss, new diabetes, Courvoisier's sign.
- Pancreas-protocol CT decides resectable / borderline / locally advanced / metastatic.
- Head — Whipple; body and tail — distal pancreatectomy with splenectomy.
- After resection — adjuvant chemotherapy for about 6 months; borderline — chemotherapy before surgery.
- CA 19-9 for follow-up only; germline testing for every patient.
Summary table
| Group | CT finding | Treatment |
|---|---|---|
| Resectable | No arterial contact; venous contact up to 180 degrees | Surgery (Whipple for the head, distal pancreatectomy for body and tail) and adjuvant chemotherapy for about 6 months |
| Borderline | Limited arterial contact or reconstructable venous involvement | Chemotherapy before surgery, then surgery if no progression |
| Locally advanced | Encasement of the superior mesenteric artery or coeliac axis of more than 180 degrees | Chemotherapy, sometimes radiotherapy; surgery only after an exceptional response |
| Metastatic | Liver or peritoneal metastases | Systemic therapy and supportive care; biliary or duodenal stent |
| Complication after Whipple | Pancreatic fistula, delayed gastric emptying, anastomotic leak | Drainage, nutritional support, treatment as needed |
Free exam questions
בן 60 .,בטיפול נמרץ, לאחר ניתוח וויפל, מפתח חום שבועיים לאחר הניתוח CT מדגים קולקציה גדולה בחלל הצפק והוא עובר ניקוז. מה מהבאים הוא המחולל הסביר שיצמח בתרביות מהניקוז? (the question as examined, in Hebrew)
- א. E. coli
- ב. Klebsiella
- ג. Pseudomonas
- ד. Stap. Aureus
איזה מהבאים נכון בנוגע לשימוש במרקרים סרטניים כבדיקות סקר? (the question as examined, in Hebrew)
- א. CEA נמצא שימושי לבדיקת סקר, אך לא נמצא בקשר להישרדות
- ב. PSA נמצא שימושי לבדיקת סקר ולרוב מתנרמל תוך חודש אחרי רדיותרפיה
- ג. AFP לא משמש לבדיקת סקר ואף אינו נמצא בקורולציה לגודל הגידול ולפרוגנוזה
- ד. CA 19-9 לא משמש לבדיקת סקר, אך נמצא בקורלציה לעומס המחלה ולפרוגנוזה
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Medical licensing exam (IMLE), General surgery, Oncology, Internal medicine, Geriatrics.
Subscriber? Read the full topic Plans and prices 25 free questions
Sources
- NCCN Clinical Practice Guidelines in Oncology: Pancreatic Adenocarcinoma, 2025 — Resectability, neoadjuvant and adjuvant therapy
- ESMO Clinical Practice Guideline: Pancreatic cancer, 2023 — Diagnosis, staging and treatment
- Sabiston Textbook of Surgery, 21st edition (2022) — Exocrine Pancreas
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.