Pancreatic_Cancer_Overview_2025.pptx management

ca pancrease

1. Pancreatic Cancer (Ca Pancreas) Comprehensive Overview - 2025 Update Sources: NCCN, ESMO, ClinicalOptions, StatPearls

2. Epidemiology & Risk Factors Pancreatic cancer accounts for ~3% of all cancers, ~7% of cancer deaths >90% are Pancreatic Ductal Adenocarcinoma (PDAC) Median age at diagnosis: 70 years Risk factors: smoking, chronic pancreatitis, diabetes, obesity, family history, BRCA1/2 mutations

3. Clinical Presentation Often asymptomatic until advanced Common symptoms: jaundice, weight loss, abdominal/back pain, anorexia New-onset diabetes in elderly can be a presenting feature Most diagnosed at unresectable stage

4. Diagnosis & Workup Imaging: Contrast-enhanced CT (pancreas protocol) is gold standard MRI/MRCP for biliary/pancreatic duct evaluation EUS with FNA for histologic confirmation Serum CA 19-9: supportive, not diagnostic

5. Staging (AJCC 8th Edition) Localized (resectable): confined to pancreas, no vessel involvement Borderline resectable: limited vessel involvement Locally advanced unresectable: extensive vessel encasement Metastatic: distant organ spread (liver, peritoneum, lungs)

6. Management Overview Multidisciplinary approach is essential Surgical resection: only curative option Systemic therapy: neoadjuvant/adjuvant or palliative Radiation: selected locally advanced/borderline cases Palliative/supportive care integral at all stages

7. Surgical Management Whipple procedure (pancreaticoduodenectomy): for head tumors Distal pancreatectomy: for body/tail tumors Total pancreatectomy rarely performed RO resection is critical for long-term survival

8. Systemic Therapy Adjuvant: modified FOLFIRINOX (preferred), Gemcitabine ± Capecitabine Neoadjuvant: mFOLFIRINOX or Gemcitabine/Nab-Paclitaxel Metastatic: mFOLFIRINOX (fit patients), Gemcitabine/Nab-Paclitaxel (others) Second-line: Nal-IRI + 5-FU/LV, FOLFOX, clinical trials

9. Targeted & Immunotherapy BRCA1/2 or PALB2 mutations → PARP inhibitors (Olaparib maintenance) MSI-H/dMMR → Pembrolizumab (rare in PDAC) NTRK fusion-positive → Larotrectinib/Entrectinib Molecular profiling recommended for all metastatic cases

10. Radiation Therapy Role controversial; used in selected locally advanced/borderline resectable Techniques: IMRT, SBRT Goal: local control, downstaging, symptom relief Ongoing trials refining indications

11. Prognosis Overall 5-year survival: ~11% Resected early-stage disease: 20–30% 5-year survival Median OS metastatic disease: 8–12 months with modern regimens Recurrence after surgery is common

12. Recent Updates (2023–2025) Universal germline testing now standard (NCCN/ESMO) Routine somatic testing in metastatic disease mFOLFIRINOX remains backbone in adjuvant & metastatic settings Increasing role of clinical trials, precision medicine

13. References NCCN Guidelines: Pancreatic Adenocarcinoma (2025) ESMO Clinical Practice Guideline + Express Update (2023–2024) StatPearls: Pancreatic Cancer ClinicalOptions: Pancreatic Cancer Slideset