Pancreas

Question 1

epidemiology

Answer 1

10th most common
48% F, 52% M
risk increases with age

Question 2

aetiology

Answer 2

fairly unsure on the risks
genetics (lower risk in O groups)
family history
BRCA 2 gene (2.5x more likely )
twice more likely for smokers
38% increase for type 1 diabetes
3% have a 5 year survival
gall stones/ gall bladder removal surgery

Question 3

what is the % of exocrine tumours

Answer 3

96

Question 4

what % is endocrine tumours

Answer 4

4

Question 5

what is the main pathology

Answer 5

adenocarcinomas (90% ductal)

Question 6

what other pathologies are there

Answer 6

sarcomas, acinar cell carcinoma (1%very rare)

Question 7

is met spread rare

Answer 7

yes

Question 8

if met spread is present where could it be

Answer 8

prostate, breast, colon, urinary bladder and ovary

Question 9

where is local spread

Answer 9

liver, peritoneum or posteriorly via the nervous system

Question 10

haematological spread

Answer 10

bone and lung

Question 11

lymphatic spread

Answer 11

pancreatico-splenico, suprapancreatic -> mesenteric + coeliac nodes and PA nodes

Question 12

presentation

Answer 12

jaundice due to blockages in the bile duct
inflammation/ pain
not many palpable masses
weightloss
changes in glucose levelsd

Question 13

diagnosis

Answer 13

CT/MRI
FDG/EPT: lymphatic involvement
Ultrasound
FBC/LFT raised CA19-9 in 70% of patients

Question 14

how many are suitable for surgery

Answer 14

<20% due to blood vessel invasion

Question 15

what type of surgery’s are there

Answer 15

pancreatic-duodectomy
distal pancreatectomy
total pancreatectomy

Question 16

what is a pancreatic-duodectomy

Answer 16

removes pancreas, duodenum, bile duct, some parts of the small bowel connected to the stomach

Question 17

what is a distal pancreatectomy

Answer 17

removes tail/distal part of the pancreas

Question 18

what is a whole pancreatectomy

Answer 18

removes the whole pancreas

Question 19

chemo

Answer 19

can be used as single or combo
gemicitabine, cape, docetaxel, cisplatin, (GEMCAP)
regime is determined by stage
RT means only one combo
if only chemo all combos are used

Question 20

RT

Answer 20

VMAT
6 months chemo induction to RT, with concurrent RT with cisplatin and carbo-platin
cat 1

Question 21

what is the dose prescription

Answer 21

50.4Gy in 28 fractions
54Gy in 30 fractions
45Gy in 25 fractions

Question 22

RT SE

Answer 22

radiation induced diabetes
confusion
dysphagia
nausea
vomiting
skin irritation
increased jaundice
fatigue
back pain
long term: liver damage, secondary malignancies, ulceration of duodenum

Question 23

what is the prognosis

Answer 23

very poor survival for pancreas and stomach

Question 24

what is the 1 year survival

Answer 24

28.4%

Question 25

what us the 5 year survival

Answer 25

5.7%