Pancreatic

Question 1

What is 5 year survival of pancreatic cancer?

Answer 1

5%

Question 2

What are risk factors for pancreatic cancer?

Answer 2

Genetic mutations - BRCA, p16
Familial syndromes - Lynch, hereditary pancreatits, Peutz Jeghers, hereditary telangectasia syndrome
Smoking
Chronic pancreatitis (alcohol)
Obesity
High saturated fat, red meat and processed foods
H pylori
HIV
Hepatitis B infection
Diabetes

Question 3

What is clinical presentation of pancreatic cancer?

Answer 3

asymptomatic until late stage
Most arise in head of pancreas (60-70%)
Jaundice, abdominal pain, steatorrhoea
New onset diabetes
Can invade locally and cause duodenal obstruction

Question 4

What is the pathology of pancreatic cancer?

Answer 4

Ductal adenocarcinoma (80%)
Neuroendocrine cancers are next most common

Question 5

How to diagnosis pancreatic cancer?

Answer 5

CT staging
EUS/ERCP for biopsy
MRI can give more detailed images if considering resection

Question 6

What is the staging of pancreatic cancer?

Answer 6

T1 - 2cm and confined to pancreas
T3 - involving extra pancreatic structures but not coeliac axis or SMA
T4 - involving coeliac axis or SMA

Question 7

What are the management strategies of pancreatic cancer?

Answer 7

Resectable - surgical resection (Whipples) followed by adjuvant chemotherapy (gemcitabine or 5-FU)
Potentially resectable - neoadjuvant chemotherapy (gemcitabine or FOLFIRINOX) followed by radiation followed by surgery if resectable
Non resectable - palliative chemotherapy (Gemcitabine +/- Nab-Paclitaxel, or FOLFIRINOX)