Pancreatic Ca

Question 1

define pancreatic cancer

Answer 1

cancer within the pancreas

usually an adenocarcionoma
pancreatic ductal carcinoma

Question 2

prognosis of pancreatic cancer

Answer 2

poor
usually not dx until late/advanced stages
5Y survival: 5-15%
overall survival: 6%

Question 3

epi of pancreatic cancer

Answer 3

10th most common cancer in men and 7th most common in women

incidence increases with age
almost >90% of cases are >55Y

Question 4

RF for panc ca

Answer 4

top risk factor: smoking! - 20% of pan cancer is caused by smoking

other
- alcohol abuse
- age
- comorbidities: DM, obesity, chronic pancreatitis, cirrhosis, H. pylori, pancreatic cysts
- occupational exposure: dry cleaning and metal working
- male
- African American > white
- fhx
- genetics: lynch syndrome MEN1, BRCA1/2

Question 5

what is the most common site of panc ca within the pancreas

Answer 5

head > body > tail

Question 6

tell me about pancreatic precursor lesions

Answer 6

most panc cancers stem from precursor lesions like
- pancreatic intraepithelial neoplasia (PanIN)
- intraductal papillary mucinous neoplasm (IPMN)
- mucinous cystic neoplasm (MCN)

so if these are discovered it’s important to monitor them regularly for changes and potential resect them before they transform

Question 7

common sites for panc ca mets

Answer 7

LN, liver, lungs, and surrounding visceral organs like intestines, stomach, and peritoneal

Question 8

what kind of s/s would you expect a panc ca pt to present with?

Answer 8

initial s/s are nonspecific esp in early stages

if mass in head of panc
- biliary obstruction s/s ➔ jaundice, steatorrhea, pale (acholic) stools, and dark urine, malabsorption, weight loss, jaundice

other
- mid-epigastric pain (mass effect)
- nighttime pain
- sudden DM onset (bc endocrine function decreases)
- pruritis (bile salts in skin)
- Courvoisier sign (palpable but nontender gallbladder)
- Trousseau syndrome: migratory thrombophlebitis (inflam rxn of a vein + thrombus)

Question 9

how to dx panc cancer?

Answer 9

CT w/ contrast

could consider biopsy via ERCP if need confirmatory pathology or no need if the pt is going straight to surgery because unstable

Question 10

what ix could we order to workup a panc ca?

Answer 10

labwork
- tumour markers: cea and ca19-9 (not to dx but as screening or to track disease progression)
- CBC
- lytes
- cr and urea
- HbA1c
- fingerprick glucose
- bilirubin ALT/ALP
- amylase and lipase
- consider genetics

imaging
- u/s to r/o ddx of stones but limited use bc hard to visualize the pancreas
- PET and CT to evaluate distant mets

Question 11

how to tx panc ca?

Answer 11

get team involved, surg onc, med onc, and palliative care

resection is the only cure
- whipple if in head of panceas
- DP if in body/tail

locally advanced, could attempt neoadjuvant chemo +/- rads
- chemo: alkylating agents and anti-metabolites

supportive care
- pain relief
- endoscopic interventions for obstructions (biliary or duodenal)
- diet and nutritional support
- psychosocial support - coping mechanisms