Pancreas Cancer Flashcards
Exocrine vs endocrine origin
95% are exocrine
Most common type in exocrine
Ductal adenocarcinoma in 80% of cases
Most common location of ductal adenocarcinoma
Head
Most important risk factor (4)
Age > 60 (30x more risk)
Smoker (25-30% of cancers are smoking related)
Fat and high caloric food
Chronic pancreatitis
T1-T3
resectable
T4
not resectable
Negative prognostic factors
> 2cm (T2) N1 Middle or badly differentiated (G2-G3) Incomplete resection R1-2 Perineural infiltration (can appear at T1-2)
Definition of R1
If tumor cell up to 1mm from resection border
Tumor marker
Ca 19-9 (can also be present with cholestasis)
Work Up
CT Abdomen Thorax mit contrast (vessel infiltration)
OGD
Typical finding on imaging
double duct sign
Place of ERCP (5)
When Biopsie
Limitation
To place a DHC Stent if
- Bilirubin > 15mg
- symptomatic pruritus
- cholangitis
- low Quick
- late OR slot
Biopsie :
- only if CT unclear
- palliative
- no biopsie if resection is possible !
Not so good to estimate extent of disease and local invasion
EUS
EUS Biopsie has no risk of dissemination
90% precise
Also 90% to predict vessel infiltration and resectability
PET CT
not standard but can change decision in 15% of cases
Operation
Only hope of curative therapy
