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Pancreatic Cancer Diabetes — SCE Medical Oncology MCQ

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ModerateGI CancersPancreatic Cancer DiabetesSCE Medical Oncology

A 55-year-old man with metastatic pancreatic cancer on FOLFIRINOX develops persistent hiccups, and his oncologist notices his blood glucose has become increasingly difficult to control. What pancreatic cancer-related paraneoplastic phenomenon may be developing?

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Correct answer: C — New-onset or worsening diabetes mellitus due to pancreatic beta-cell destruction by tumour — pancreatic cancer is associated with new-onset diabetes in approximately 25-40% of cases

New-onset diabetes mellitus (or worsening of pre-existing diabetes) is increasingly recognised as both a risk factor for and early manifestation of pancreatic cancer. Approximately 25-40% of pancreatic cancer patients develop diabetes within 2-3 years before diagnosis. The mechanism involves tumour-derived mediators (S100A8 islet amyloidosis) and direct beta-cell destruction. Worsening glycaemic control during treatment may reflect disease progression or treatment effects (corticosteroids).

Reference: ESMO 2024 Pancreatic Cancer Guidelines; Sharma et al Pancreas 2018