1 / 55

Northern California SGNA Fall Conference 2010 Pancreas Neoplasms

Northern California SGNA Fall Conference 2010 Pancreas Neoplasms. Randall E Lee, MD, FACP Gastroenterologist, VA NCHCS Associate Clinical Professor of Medicine, UC Davis. Disclaimer. No financial conflicts of interest or sponsorships. Pancreas neoplasms.

noe
Download Presentation

Northern California SGNA Fall Conference 2010 Pancreas Neoplasms

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. Northern California SGNAFall Conference 2010Pancreas Neoplasms Randall E Lee, MD, FACP Gastroenterologist, VA NCHCS Associate Clinical Professor of Medicine, UC Davis

  2. Disclaimer • No financial conflicts of interest or sponsorships

  3. Pancreas neoplasms • Pancreas anatomy, embryology, physiology • Pancreas endocrine neoplasms • Pancreatic adenocarcinoma • Pancreas cystic neoplasms

  4. Pancreas anatomy

  5. Pancreas Embryology

  6. Pancreas physiology • Exocrine • Endocrine

  7. Pancreas physiology • Exocrine • Secretion into a duct • Endocrine

  8. Pancreas physiology • Exocrine • Secretion into a duct • Endocrine • Secretion directly into the bloodstream

  9. Pancreas structure • Acini • Islets

  10. Pancreas structure • Acini • Connected to ducts • Exocrine function • Islets

  11. Acini • Connected to ducts • Exocrine function • “acinarization” • Islets

  12. Pancreas structure • Acini • Islets • Not connected to ducts • Endocrine function

  13. Pancreas structure • Acini • Connected to ducts • Exocrine function • “acinarization” • Islets • Not connected to ducts • Endocrine function

  14. Pancreas physiology • Exocrine • Amylase: carbohydrate • Lipases: fat • Proteases: protein • Endocrine

  15. Pancreas physiology • Exocrine • Amylase: carbohydrate • Lipases: fat • Proteases: protein • Endocrine

  16. Pancreas physiology • Exocrine • Endocrine • Insulin (beta cells) • Glucagon (alpha cells) • Pancreatic polypeptide (PP cells) • Somatostatin (D cells)

  17. Pancreas neoplasms

  18. Pancreatic endocrine neoplasms • Insulinoma • Gastrinoma • Glucagonoma • VIPoma

  19. Pancreas endocrine neoplasms • Insulinoma • hypoglycemia • Gastrinoma • Glucagonoma • VIPoma

  20. Pancreas endocrine neoplasms • Insulinoma • Gastrinoma • “Zollinger-Ellison Syndrome” • Peptic ulcer, GERD, diarrhea • Gastrin is not normally produced in the pancreas! • Glucagonoma • VIPoma

  21. Pancreas endocrine neoplasms • Insulinoma • Gastrinoma • Glucagonoma • Hyperglycemia • Weight loss • Rash • VIPoma

  22. Glucagonoma rash: Necrolytic migratory erythema

  23. Pancreas endocrine neoplasms • Insulinoma • Gastrinoma • Glucagonoma • VIPoma • Severe diarrhea • Hypokalemia • Volume depletion

  24. Pancreatic endocrine neoplasm localization: CT SR scintigraphy “Octreoscan” EUS

  25. Pancreas endocrine neoplasm: treatment • Medical suppression of symptoms • Surgical resection

  26. Pancreas neoplasms

  27. Pancreas adenocarcinoma • Usually arises from the duct • Men more than women, older than 45 years • Generally poor long-term prognosis • No good screening / early detection methods

  28. Pancreas adenocarcinoma: perspective

  29. Pancreas adenocarcinoma: perspective National Cancer Institute, 2010

  30. Pancreas adenocarcinoma: risks

  31. Pancreas adenocarcinoma: clinical presentation • Location! • Location! • Location!

  32. Pancreas adenocarcinoma: clinical presentation • Symptoms occur late in disease course. • Head of pancreas: • Jaundice • Palpable non-tender gallbladder (Courvoisier’s sign) • Advanced: • Fat malabsorption: steatorrhea • Pain • Fatigue, anorexia, weight loss

  33. Pancreas adenocarcinoma: diagnosis • CT +/- biopsy • MRCP • ERCP & brushing / biopsy • EUS & FNA

  34. Pancreas adenocarcinoma: CT

  35. ERCP: “Double-duct” sign

  36. Pancreas malignancy: ERCP • Sphincterotomy • Grounding pad, generator, sphincterotome • Strictures • Guidewire(s), dilators, stents • Cytology brush, glass slides, fixative

  37. Pancreas malignancy: EUS • Fine-needle aspiration & biopsy • Coordinate with pathologist • Cytology fixative, glass slides

  38. Pancreas adenocarcinoma: treatment • Curative resection • Palliative therapy

  39. “Whipple procedure” = pancreaticoduodenectomy

  40. Pancreas adenocarcinoma: survival after Whipple

  41. Pancreas adenocarcinoma: treatment • Curative resection • Palliative therapy

  42. ERCP • cannulation

  43. ERCP • sphincterotomy

  44. CBD stent

  45. Pancreas Adenocarcinoma: survival

  46. Pancreas neoplasms

  47. Pancreas neoplasms: cystic • Mucinous cystic neoplasms • Serous cystadenomas • IPMNs

  48. Mucinous cystic neoplasm • Cystic tumors filled with mucin • Women > men • Body & tail of pancreas • Always considered premalignant / malignant • Surgical resection

  49. Serous cystadenoma • Cystic tumor filled with serous fluid • Women > men • Body & tail of pancreas • Generally benign, but can cause complications

  50. I P M N

More Related