Pancreatic cancer

Question 1

What are the indications for genetics referral in pancreatic cancer?

Answer 1

Pancreatic cancer <50yrs
Pancreatic cancer <60yrs AND breast cancer <60yrs, melanoma <60yrs OR ovarian cancer <60 years.
Pancreatic cancer <60yrs AND FDR or SDR pancreatic cancer <60yrs
Pancreatic cancer <60yrs AND two FDR or SDR with any of breast, melanoma or orarian cancer <60yrs

Question 2

Which are the most common inherited pancreatic cancer syndromes?

Answer 2

BRCA2
Familial atypical multiple mole melanoma (FAMM)- melanoma and pancreatic cancer

Question 3

Which gene defect is associated with Familial atypical multiple mole melanoma?

Answer 3

CDKN2A (p16)

Question 4

How does the management of BRCAm pancreatic cancer differ?

Answer 4

More likely to respond to platinum based chemotherapy therefore cisplatin and gemcitabine generally recommended first line.

Question 5

What contact with the SMA means that pancreatic cancer is not operable

Answer 5

Typically >180 degrees contact

Question 6

Optimal management of locally advanced inoperable pancreatic cancer?

Answer 6

Neoadjuvant FOLFIRINOX followed by resection if significant downstaging or chemoradiotherapy.

Question 7

What percentage of patients are sufficiently downstaged with NACT and proceed to surgery?

Answer 7

10%