Chapter 20: MNT for Pancreatic Cancer Flashcards
Pancreatic tumors arise from ____ & ____ cells.
Exocrine and endocrine
Which is more common? Exocrine or endocrine tumors?
Exocrine. Accounts for 93% of pancreatic cancer cases. Survival rates are poorer.
Most common type of pancreatic cancer is ____.
Adenocarcinoma
Also referred to as ductal cell carcinoma or ductal adenocarcinoma. 95% of exocrine tumors are pancreatic adenocarcinomas.
Risk factors for pancreatic cancer include
Family history
Cigarette smoking
Obesity and abdominal adiposity
Chronic pancreatitis
Diabetes mellitus
Heavy drinking (>3 drinks per day)
Diet high in total fat, saturated fat, red mea, processed meat, or fructose containing foods and beverages.
What lab is likely to be elevated with pancreatic cancer?
Carbohydrate Antigent 19-9 (CA 19-9)
Staging Methods
Resectability staging is based on imaging, CA 19-9 level, patient performance.
Tumors are divided into 3 groups
Resectable (potentially curable)
Borderline resectable
Unresectable (advanced or metastatic)
How is resectable PC treated?
Combination of surgery and systemic treatment. ChemoRT may or may not be included.
Treatment for borderline resectable PC?
Starts with systemic treatment. Subsequent treatment may or may not include surgery, radiation, or both.
Treatment for unresectable PC?
Systemic therapy is used. Largely for palliation.
What is systemic therapy for PC?
Usually a combination of 2 drugs but single agents may be given in cases of poor performance status.
Chemo is often given at the same time of radiation to enhance radiosensitization of the tumor.
Common Chemos
- Capecitabine (Xeloda): mucositis, stomatitis, nausea, vomiting, diarrhea
- Cisplatin (Platinol-AQ): anorexia, taste changes, nausea, vomiting, diarrhea, sodium wasting, magnesium wasting
- Docetaxel (Taxotere): anorexia, mucositis, stomatitis, nausea, vomiting, diarrhea
- Fluorouracil: taste changes, mucositis, stomatitis, nausea, vomiting, diarrhea
- Gemcitabine (Gemzar): anorexia, nausea, vomiting
- Irinotecan (Camptosar), Liposomal irinotecan (Onivyde): anorexia, mucositis, stomatitis, nausea, vomiting, diarrhea
- Oxaliplatin (Eloxatin): taste changes, nausea, vomiting, diarrhea, cold sensitivity
Targeted Therapy
Erlotinib (Tarceva): anorexia, nausea, vomiting, diarrhea
Immunotherapy
Pembrolizumab (Keytruda): anorexia, nausea, vomiting, diarrhea, constipation
First or second line drug combinations for patients with good performance status
FOLFIRINOX: fluorouracil, leucovorin, oxaliplatin, and irinotecan
GA: gemcitabine and albumin-bound paclitaxel, also known as nab-paclitaxel (Abraxane)
First line therapy for patients with poor performance status
GX: gemcitabine and capecitabine (Xeloda)
GEM-E: gemcitabine and erlotinib (Tarceva)
Less Common Drug Combinations
CapeOx or Xelox: capecitabine and oxaliplatin
FOLFIRI: fluorouracil, leucovorin, and irinotecan (or liposomal irinotecan)
FOLFOX: fluorouracil, leucovorin, and oxaliplatin
GemCis: gemcitabine and cisplatin
GTX: gemcitabine, docetaxel, and capecitabine
Role of RT
May be given in neoadjuvant setting to improve chances of clean surgical margins, as adjuvant therapy to help sterilize positive margins, or in those with positive lymph nodes to help reduce the chance of local recurrence.
Surgery is determined by the ____ rather than pathologic type.
location of the cancer
What are the 2 types of pancreaticoduodenectomy (PD)
Whipple (standard PD)
Pylorus-preserving pancreaticoduodenectomy (PPPD)
Nutrition impact symptoms of Whipple
Pancreatic insufficiency
Dumping syndrome
Delayed gastric emptying
Lactose intolerance
Diabetes mellitus
Nutrition impact symptoms of PPPD
Pancreatic insufficiency
Delayed gastric emptying
Lactose intolerance
Diabetes mellitus
Nutrition impact symptoms of total pancreatectomy
Pancreatic insufficiency
Dumping syndrome
Delayed gastric emptying
Lactose intolerance
Diabetes mellitus
Nutrition impact symptoms of distal pancreatectomy
Pancreatic insufficiency
Diabetes mellitus
Weight loss and malnutrition occurs in ____ to ____ % of patients.
50-90%
_____ % of PC patients experience cachexia by time of death.
70-80%
Common symptoms at time of diagnosis
Jaundice
Clay colored stools
Dark urine
Itchy skin
Pain
Weight loss
Anorexia
Malabsorption
Delayed gastric emptying or gastric outlet obstruction
Diabetes mellitus
Ascites