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Pancreatic Cancer

Pancreatic Cancer. L. Okolicsanyi G. Morana. Pancreas Cancer. 2nd most common GI malignancy 30,000 cases per year in US 25,000 deaths per year 4 th leading cause of death in both men and women Incidence slowly rising M>F (1.3:1) Rare before 45 yrs. Pancreas Cancer Etiology.

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Pancreatic Cancer

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  1. Pancreatic Cancer L. Okolicsanyi G. Morana

  2. Pancreas Cancer • 2nd most common GI malignancy • 30,000 cases per year in US • 25,000 deaths per year • 4th leading cause of death in both men and women • Incidence slowly rising • M>F (1.3:1) • Rare before 45 yrs

  3. Pancreas CancerEtiology • Diabetes mellitus • Diet: Nitrosamines, Animal fat • Cigarettes • Hereditary predisposition (Hereditary pancreatitis) • Family cancer syndromes (e.g., Peutz-Jeghers, Von Hippel-Lindau, Gardner’s) • Benign disease: Chronic pancreatitis, Intraductal papillary mucinous neoplasms

  4. Normal Pancreas

  5. Pancreatic Tumors • Epithelial • Ductal epithelium (adenocarcinoma and others) • Cystic neoplasms, serous or mucinous • Endocrine • Islet cell tumors, carcinoid tumors • Exocrine • Acinar cell carcinoma • Mesenchymal-Rare

  6. Risk Factors for Pancreatic Cancer

  7. Relevance of Genetic Mutations in Pancreatic Cancer

  8. Pancreas CancerClinical Features • Weight loss • Head: • Painless jaundice • Gastric outlet obstruction • Body & Tail • Pain • Diabetes mellitus without family history • Metastasis: Hepatomegaly, ascites, Virchow’s (left supraclavicular) node, Trousseau’s syndrome (migratory superficial thrombophlebitis)

  9. Pancreas CancerCourvoisier’s law “In the presence of jaundice a palpable gall bladder is unlikely to be due to stone”

  10. Pancreas CancerInvestigations • Laboratory tests: • LFT’s • CA 19-9 • Radiologic tests: • Ultrasound • CT scan + biopsy • ERCP + biopsy • EUS + biopsy

  11. Algorithm for diagnosis and staging of Pancreatic Cancer FNAC

  12. Pancreas CancerTreatment • Curative: • Resection if possible • Unresectable if metastasis or major vessel involvement • Whipple procedure for head (radical pancreatoduodenectomy) • Distal pancreatectomy for body & tail • Palliative: • Bypass • Stent

  13. Actuarial Survival after Pancreatico- duodenectomy

  14. Pancreas CancerSurvival at 5 yrs • Head of Pancreas 5-15% • Body & Tail of pancreas 2% • Distal CBD 15-35% • Ampulla 30-65% • Mild improvement with adjuvant therapy

  15. Pancreas Cancer

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