Pancreas Flashcards
epidemiology
10th most common
48% F, 52% M
risk increases with age
aetiology
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
what is the % of exocrine tumours
96
what % is endocrine tumours
4
what is the main pathology
adenocarcinomas (90% ductal)
what other pathologies are there
sarcomas, acinar cell carcinoma (1%very rare)
is met spread rare
yes
if met spread is present where could it be
prostate, breast, colon, urinary bladder and ovary
where is local spread
liver, peritoneum or posteriorly via the nervous system
haematological spread
bone and lung
lymphatic spread
pancreatico-splenico, suprapancreatic -> mesenteric + coeliac nodes and PA nodes
presentation
jaundice due to blockages in the bile duct
inflammation/ pain
not many palpable masses
weightloss
changes in glucose levelsd
diagnosis
CT/MRI
FDG/EPT: lymphatic involvement
Ultrasound
FBC/LFT raised CA19-9 in 70% of patients
how many are suitable for surgery
<20% due to blood vessel invasion
what type of surgery’s are there
pancreatic-duodectomy
distal pancreatectomy
total pancreatectomy
what is a pancreatic-duodectomy
removes pancreas, duodenum, bile duct, some parts of the small bowel connected to the stomach
what is a distal pancreatectomy
removes tail/distal part of the pancreas
what is a whole pancreatectomy
removes the whole pancreas
chemo
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
RT
VMAT
6 months chemo induction to RT, with concurrent RT with cisplatin and carbo-platin
cat 1
what is the dose prescription
50.4Gy in 28 fractions
54Gy in 30 fractions
45Gy in 25 fractions
RT SE
radiation induced diabetes
confusion
dysphagia
nausea
vomiting
skin irritation
increased jaundice
fatigue
back pain
long term: liver damage, secondary malignancies, ulceration of duodenum
what is the prognosis
very poor survival for pancreas and stomach
what is the 1 year survival
28.4%
what us the 5 year survival
5.7%
