Chapter 24: MNT for Pancreatic and Bile Duct CA

Question 1

What type of cells can get be cancerous in pancreatic tumors? Which are more common?

Answer 1

Exocrine or Endocrine Cells
Exocrine represents 95% of pancreatic CAs
90% being Ductal Cell Carcinoma (adenocarcinoma)

Question 2

What is the survival rate for exocrine pancreatic CA?

Answer 2

4%

5-10% of cases, the disease is caught early enough to complete surgical resection is achieved, in this group the 5-yr survival is up to 18-24%

In advanced cases - 1% at 5 years

Question 3

What is the survival rate for endocrine pancreatic CA?

Answer 3

42% of neuroendocrine tumors
55% of resected localized endocrine tumors
15% of non-resectable tumors

Question 4

What is the survival rate for bile duct CA? Ampullary?

Answer 4

25% of bile duct

30-50% of ampullary

Question 5

What are the possible nutritional implications of a Pancreaticoduodenectomy (PD—Whipple)? What are the anatomic changes?

Answer 5

Exocrine Insufficiency, dumping syndrome, delated gastric emptying, lactose intolerance, Diabetes/glucose intolerance

Head of pancreas, duodenum, gallbladder, distal stomach, and part of common bile duct are removed

Question 6

What are the possible nutritional implications of a Pylorus preserving pancreaticduodenectomy (PPPD)? What are the anatomic changes?

Answer 6

Exocrine Insufficiency, delated gastric emptying, lactose intolerance, Diabetes/glucose intolerance (No dumping)

Head of pancreas, duodenum, gallbladder and part of common bile duct are removed (stomach and pylorus are kept intact)

Question 7

What are the possible nutritional implications of a Total pancreatectomy (TP)? What are the anatomic changes?

Answer 7

Exocrine Insufficiency, dumping syndrome, delated gastric emptying, lactose intolerance, Diabetes/glucose intolerance

*Definitely occurring

Entire pancreas and sometimes spleen in addition to duodenum, gallbladder, distal stomach and part of common bile duct are removed

Question 8

What are the possible nutritional implications of a Distal pancreatectomy? What are the anatomic changes?

Answer 8

Only exocrine insufficiency and diabetes/glucose intolerance

Removes only tail (or tail and part of body) of pancreas, possibly spleen

Question 9

What are the common chemos used for pancreatic CA?

Answer 9

Xeloda
Cisplatin
Taxotere
Adriamycin
5-FU
Gemzar
Irinotecan
Mitomycin C
Oxaliplatin
Taxol
Tarceva

Question 10

What % of pancreatic CA patients have PEI?

Answer 10

80-90%

Question 11

What are the S/S of pancreatic exocrine insufficiency (PEI)?

Answer 11

abd bloating
cramping after meals
excessive gas (burping/flatulence)
fatty stools
frequent stools
foul smelling stools or gas
floating stools
indigestion
loose stools
unexplained weight loss

Question 12

What % of patients with normal exocrine function need long-term treatment for PEI after a Whipple?

Answer 12

50%

Question 13

If patients are having steatorrhea should restrict their fat intake to what amount daily? What could be substituted?

Answer 13

75 grams per day

MCTs - don’t require enzymatic action of bile salts for digestion or absorption

Question 14

What are the different brands of Pancreatic Enzymes?

Answer 14

Creon
Pancreaze
Pertzye
Ultresa
Viokace
Zenpep