Pancreatic cancer

pancreatic cancer,diagnosis and treatment

1. Pancreatic Cancer by RAMKUMAR

2. Pancreas - Anatomy

3. Overview Pancreatic cancer develops when a cell in the pancreas acquires damage to its DNA that causes A single  cell to grows and divides rapidly, becoming a tumor that does not respect normal boundaries in the body. 

4. Pancreatic Epithelial Malignancies : Malignant Ductal adenocarcinoma (majority) Mucinous cystadenocarcinoma Acinar cell carcinoma Small cell carcinoma Uncertain malignant potential Mucinous cystadenoma Solid and cystic papillary neoplams

5. Pathology: mostly ductal adenocarcinoma (metastasizes early; presents late) Location of tumor: - 60% head - 25% body - 15% tail

6. Epidemiology: 10 th most common cancer . 4 th leading cause of cancer death. 80% of cases are adenocarcinomas from exocrine pancreas Less common exocrine tumors include: IPMN Mucinouscystadenocarcimomas Most common in black males Median age of diagnosis is 70

7. Causes And Risk Factors: Pancreatic cancer is fundamentally a disease caused by damage to the DNA. This damage is often referred to as mutations .(Inheritance or Carcinogens). Smoking Age, gender Obesity Diet – high fat, low fibre Chronic pancreatitis Family history – BRCA2 Β- napthylamine

8. Sign & Symptoms : Jaundice P ain in the upper or middle abdomen and back U nexplaind weight loss L oss of appetite Fatigue Trousseau’s syndrome Clinical Depression

9. Diagnostic Procedures: Identifying risk factors. Mass during physical Examination Ultrasound Bile duct distension Mass CT scan with IV contrast Triple phase CT (pancreas protocol) 90% accurate at finding lesions   A scanner takes multiple X-ray pictures, and a computer reconstructs them into detailed images of the inside of the abdomen

10. Endoscopic ultrasound Help find lesions not seen on CT Help determine resectability Excellent way to get biopsy MR cholangiopancreatography (MRCP) , which can be used to look at the pancreatic and bile ducts, is described below in the section on cholangiopancreatography . MR angiography (MRA) , which looks at blood vessels, is mentioned below in the section on angiography.

11. MRCP ULTRASOUND CT SCAN

12. Endoscopic retrograde cholangiopancreatography (ERCP):   For this test, an endoscope (a thin, flexible tube with a tiny video camera on the end) is passed down the throat, through the esophagus and stomach, and into the first part of the small intestine. This is usually done while you are sedated (given medicine to make you sleepy ).  A small amount of dye (contrast material) is then injected into the common bile duct, and x-rays are taken.  The x-ray images can show narrowing or blockage in these ducts that might be due to pancreatic cancer.  ERCP can also be used to place a stent (small tube) into a bile or pancreatic duct to keep it open if a nearby tumor is pressing on it.

13. Stages of pancreatic cancer: I II III IV

14. Stages :

15. Sites of Metastasis: Liver Peritoneum Lung Adrenal Bone Rarely CNS

16. Treatment Approach

17. Treatment Approach

18. Surgery: Surgery with the intention of a cure is only possible in around one-fifth (20%) of new cases . Whipple`s procedure total pancreatectomy distal pancreatecto my radiation therapy chemotherapy

19. Whipple`s procedure:

20. Management of Locally Advanced Pancreatic Cancer: Conventional external beam radiation therapy Concomitant Chemoradiotherapy 5-FU Gemcitabine Paclitaxel

21. Management of Metastatic Pancreatic Cancer: Pain Control Long-acting narcotics Neurolytic celiac plexus block (NCPB) PERT PPI Bacterial overgrowth Endoscopic Stenting of Biliary and Pancreatic Obstruction

22. Chemotherapy for Metastatic Pancreatic Cancer 5-FU Gemcitabine Median survival times versus 5-FU Survival rate at 12-months Toxicities Optimizing efficiency Combination Chemotherapy Trials

23. Prognosis: Overall prognosis seems dismal 70-80% of patients present as inoperable due to metastatic disease or locally advanced disease Median survival only 4-6 months 20-30% are operable with localized or resectable locally advanced disease Successful operation can give five year survivals from 20-30%

24. Conclusions Since 1996, 20 randomized phase III trials have failed to produce improvement in survival outcomes. Metastatic pancreatic cancer is one of the most frustrating malignancies to treat. For now, gemcitabine , gemcitabine + erlotinib , and second-line treatment with OFF has shown benefit. Supportive care strategies should be emphasized.

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