Pancreatic cancer Flashcards

1
Q

function of pancreas

A

-excretes enzymes to break down fats , carbs , protein, and nucleic acid in food

-secretes insulin and glucagon to control blood sugar levels

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2
Q

Types of Pancreatic Cancer:
most common

A

ductal adenocarcinoma 80-90%

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3
Q

Prognosis

A

carries a high mortality rate
1 year survival=24%
5 year survival=9%

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4
Q

Aetiology

A

-smoking- 20% of cancer
-hereditary-10% (genetic predisposition or inherited cancer syndromes)
-chronic pancreatitis
-genetic disorders associated with the BRCA1, BRCA2, PALB2, and ATM genes
-obesity

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5
Q

signs and symptoms

A

-early stages is usually asymptomatic
-80% of patients are diagnosed at late stages

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6
Q

signs and symptoms: early onset symptoms

A

-abdominal pain
-bloating
-flatulence
-vomiting
-change in bowel habits (constip or dia)

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7
Q

signs and symptoms: late onset symptoms

A

-abdominal or mid back pain
-obstructive jaudince (caused by compression of distal common bile duct)
-weight loss
-dark urine or light colour stool

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8
Q

Diagnostic Workup: Imaging used to

A

-define anatomy- is there a mass and what is the extent
-determine pathology -fine needle aspiration by EUS or CT
-dictate management- is the cancer restectable

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9
Q

indications of imaging modalities used to investigate pancreatic tumours:
-US
-CT
-MRI
-ENDOSCOPIC ULTRASOUND

A

-primary investigation for jaundice and epigastric pain
-investigation of choice for when pancreatic cancer is suspected
-used when CT findings are inconclusive
-problem solver. Most useful when there is a biliary obstruction w no definite mass in CT or MRI

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10
Q

what is biomarkers

A

looks for genes , proteins and other substances that gives info about the cancer

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11
Q

Biomarkers for Differential Diagnosis:
CA-19 features

A

-NOT FOR screening
-poor predictive value for cancer
-CA-19 value will still be normal w patients in early stage
-when elevated indicates advanced stage cancer
-may be more useful in surveillance

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12
Q

stage IA & IB

A

purely based on size of tumour
T1= less than or 2cm
T2=inbetween 2 and 4cm

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13
Q

Stage IIA

A

T3 ( greater than 4cm) but N= -ve

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14
Q

Stage IIA

A

T1,T2 or T3
N1

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15
Q

stage IIB

A

T1, T2 or T3
N1 = Stage IIB disease

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16
Q

stage III

A

Irrespective of T status,
N2 = Stage III OR T4, any N
cancer is 4 or more lymph nodes

17
Q

Stage IV

A

Irrespective of T and N status,
M +ve

18
Q

Treatment Options

A
  • resectable = neo or adj RT
    -locally adv or unresectable= palli or neo(surgery after)
    -metastatic= palli
19
Q

An MDT approach is imperative…

A

-onc
-surgeon
-radiologist
-gastroenterologist
-RO
-pathologist
-social worker
-dietician

20
Q

Contraindications for resection include:

A

-liver, lung and peritoneal mets
-distant LN
-aortic invasion or encasement
-major encasement of SMA,SMV, ceolic or hepatic arteries

21
Q

At time of diagnosis

A

-20% have resectable tumour
-30% locally advanced tumour that is unresectable
-50% have metastatic disease

22
Q

tx options for resectable or borderline resectable

A

-neo therapy
-surgery
-postoperative chemo
-postoperative chemoRT

23
Q

tx options for locally advanced pancreatic cancer

A

-chemo w or w/o targeted therapy
-chemoRT
-surgery
-palli surgery

24
Q

tx options for metastic or recurrent pancreatic cancer

A

-chemo w or w/o targeted therapy

25
Q

Neoadjuvant Treatments:Key messages for
-locally advanced stage disease
-borderline resectable disease
-resectable disease

A

-yes as it may enable surgical resection
-important role
-more evidence needed

however in 2023, No impact on OS or DFS; however,
improved the chance of R0 resectability

26
Q

Surgical Management: Stage I and II

A

-surgical resection
-distal pracreatectomy with splenectomy
-pancreaticduodenectomy “whipple procedure”

27
Q

surgical resection

A

-total pancreatectomy doesnt improve survival compared to partial resection

28
Q

-distal pracreatectomy with splenectomy

A

used for body and tail cancers

29
Q

-pancreaticduodenectomy “whipple procedure”

A

used for cancers in head of pancreas

30
Q

-pancreaticduodenectomy “whipple procedure”

A

used for cancers at the head of pancreas

31
Q

Adjuvant Treatments for Stage I and II:
for who
when

A

-For surgical patients with curative intent
-Within 12 weeks post surgery; typically adjuvant chemo

32
Q

-Approx how many of patients don’t go on to receive the intended adjuvant treatments?
-why?

A

«25%

«-surgical complications
-poor performance status and co-morbidities
-patient refusal
-disease relapse

33
Q

Adjuvant Treatments for Stage I and II:
The role of chemotherapy as per NCI 2022

A

-for patient w good PS: adjuvant FOLFIRINOX or combination of gemcitabine and capecitabine

-for older patients or patients w poorer PS: adjuvant gemcitabine or 5FU as a single agent therapy