Pancreatic CA

Question 1

Risk factors for pancreatic CA

Answer 1

age, smoking, pancreatitis (inherited or acquired)

also hepatitis infection, DM, genetic predisposition like BRCA and LKB1

Question 2

etiology of pancreatic CA: inherited genetics

Answer 2

there is a 3X incr. risk of pancreatic cancer in relatives of ppl with pancreatic CA
10% are due to an inherited predisposition:
BRCA2, familial pancreatic cancer, hereditary pancreatitis, HNPCC (lynch syndrome), familial atypical malignant melaonoma syndrome

Question 3

genetics of ductal adenocarcinomas

Answer 3

KRAS mutations. difficult to develop targeted therapies because the mutation inactivates KRAS’s normal metabolic function?
P16
others: P53, BRCA2, SMAD4, LKB1

Question 4

Early steps in pancreatic cancer?

Answer 4

yes. there are PanINs: pancreatic intraepithelial neoplasms. these are pre-cancerous lesions. the are seen in association with cancers and incidentally at autopsies. unclear why some just sit there and others develop into cancers.

Question 5

presenting signs and symptoms of pancreatic cancer

Answer 5

abdominal pain, jaundice, weight loss, new-onset DM, thromboembolism including migratory thrombophlebitis
look for metastatic disease: left supraclavicular adenopathy, periumbilical adenopathy, pelvic mets around the perirectal region

Question 6

What do I need to know about tx for pancreatic cancer?

Answer 6

even if the tumor can be resected, survival is very poor- 5 yr survival still under 20%. And, it matters who is doing the surgery: you want an experienced physician in a hospital with a high volume of these surgeries.
as for chemo, gemcitabine is the standard of care. And, it is also good for patients who have received surgery.
Radiation indicated if the cancer is almost rescectable (localized). Gives symptomatic relief.