1 / 11

PANCREATIC CANCER

PANCREATIC CANCER. PANCREATIC CANCER. DUCTAL ADENOCARCINOMAS (90%) ISLET CELL TUMORS NEUROENDOCRINE TUMORS Head of the pancreas – frequent site. PANCREATIC CANCER. 72 years old – median age of diagnosis 65-84 years old – peak incidence Males > Females Risk Factors:

elias
Download Presentation

PANCREATIC CANCER

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. PANCREATIC CANCER

  2. PANCREATIC CANCER • DUCTAL ADENOCARCINOMAS (90%) • ISLET CELL TUMORS • NEUROENDOCRINE TUMORS • Head of the pancreas – frequent site

  3. PANCREATIC CANCER • 72 years old – median age of diagnosis • 65-84 years old – peak incidence • Males > Females • Risk Factors: • Cigarette Smoking, Obesity, Non-hereditary Chronic Pancreatitis • Environmental Factors (diet, coffee), previous partial gastrectomy or cholecystectomy and H. pylori

  4. CLINICAL FEATURES • Common presenting symptoms • Pain • More of a problem with lesions in the body or tail • Dull ache in the upper abdomen radiating to the back and may characteristically improve upon leaning forward • Intermittent and may worsen with meals • Obstructive Jaundice • pruritus, pale stools and dark urine • Weight loss • Anorexia, early satiety, malabsorption or diarrhea/steatorrhea • Anorexia

  5. PHYSICAL FINDINGS • (+) Courvoisier’s sign • Palpable, nontender gallbladder • (+) Virchow’s Node • Advanced Disease • Abdominal Mass, Hepatomegaly, Splenomegaly, Ascitis

  6. DIAGNOSTIC PROCEDURES • Ultrasound • CT scan • Show pancreatic mass, dilatation of the biliary system or pancreatic duct, distal spread to the liver, regional lymph nodes or peritoneum • ERCP • Stricture or obstruction, obtain brushings of a stricture for cytology or for placing stents • Endoscopic Ultrasound • Small lesions (<2-3cm), local staging • MRCP • Defines anatomy of the pancreatic duct and biliary tree • FDG-PET • Excluding occult distal metastasis

  7. CA 19-9 • Serum Marker • 80-90% sensitivity and specificity • Suggestive of the diagnosis of pancreatic cancer • May be elevated in patients with jaundice without pancreatic cancer • Prognostic impilcations • Very high levels with inoperable disease • Serial evaluation is useful for monitoring response to treatment • Detecting recurrence in patients with completely resected tumors

  8. TREATMENT • Symptom management • Advanced Pancreatic Cancer • With metastatic or locally advanced inoperable disease and are the majority with newly diagnosed disease • Endoscopic biliary or duodenal stenting • Intestinal bypass surgery • Deoxycytidine analogue Gemcitabine • Single agent 1,000 mg/m2 weekly for 7 weeks followed by 1 week rest then weekly for 3 weeks every four weeks thereafter • Median survival – 6 months, 12 months (18%)

  9. TREATMENT • Operable Disease • Complete surgical resection (Stage I or II) with distant metastases excluded by prior CT is potentially curative • Lymph node-negative disease, smaller tumors (<3cm) negative resection margins and well-differentiated tumors • Surgery preceded by laparoscopy • To exclude peritoneal metastases

  10. TREATMENT • WHIPPLE PROCEDURE/ Pancreaticoduodenectomy • Standard operation for cancers of the head or uncinate process of the pancreas. • Involves resection of the pancreatic head, duodenum, 1st 15cm of jejunum, common bile duct, and gallbladder and a partial gastrectomy, with the pancreatic and biliary anastomosis placed 45 – 60 cm proximal to the gastrojejunostomy

More Related