Pancreatic Cancer

Question 1

General characteristics of pancreatic cancer

Answer 1

2% of malignant culture
Peak age: 60-80
Males slightly more than females

Locations:
70%Head>20%body>10%tail

Metastasis
Early lymph and haem spread
Liver, peritoneum, lungs

Question 2

RF for pancreatic cancer

Answer 2

Smoking

Chronic pancreatitis/cholecystitis

Chemicals: DDT, benzidine, napthalamine

Hereditary recurrent pancreatitis

Family

Genetic risk: EGFR over expression

Question 3

Histology of pancreatic carcinoma

Answer 3

Exocrine pancreas tumors(95%)

-ductal carcinoma(80%) adenocarcinoma from pancreatic duct epithelium
-acinar carcinoma(10%)
Adenocarcinoma from acinar epithelium
-papillary(5%)
-adenosquamous(5%)

Endocrine pancreas tumors(5%)

• insulinoma
• glucagonoma
• gastronoma
• carcinoid
• VIPoma

Question 4

sx of pancreatic cancer

Answer 4

Fatigue& anorexia
Weight loss most common sx
Belt like pain in upper abdomen and back
Jaundice in 50%
Courvosier sign: palpable non tender resistance in the area

Question 5

Dg of pancreatic cancer

Answer 5

Medical history 
History: for RF 
Clinical exam 
-palpable tumour in upper abdomen 
-jaundice 
-ascites 
-splenomegaly
-courvosier sign 

Lab: amylase, lipase, glucose, calcium, GGT, ALP, LDH,

Tumour markers: CEA, CA-19( for prognosis)

Question 6

Complications of pancreatic cancer

Answer 6

Pancreatitis 
Hyper coagulation - embolism 
Splenomegaly if splenic vein obstructed 
Pancreatic failure sx 
Ileus

Question 7

Therapy guidelines of pancreatic cancer

Answer 7

Usually late dg in advanced stage
Early dg is rare and rx w/ radical surgery

Adjuvant chemo therapy
-reduces rate of relapse and increases survival rate

Neoadjuvant radiochemotherapy
-used for pts w/ operable tumors w/ LN metastasis

Palliative cases require supportive rx

Question 8

Radiotherapy for pancreatic cancer

Answer 8

Indications: pain & symptomatic carcinomas

Combination w/ chemotherapy

Question 9

Chemotherapy in pancreatic cancer

Answer 9

Poor chemotherapy response
6-fluorouracil isn’t very effective
Anthracycline is more effective
Polychrmotherapy over mono

Target therapy w/ ertolinib and gemcitabin In metastasis

Question 10

Palliative rx in pancreatic carcinoma

Answer 10

Control pain

• inactivate coeliac ganglion
  1) w/ CT guided alcohol
  2) splanchnicextomy

Enteral feeding: duodenal feeding tube 
rx of jaundice: 
1)percutaneous Transhepatic drainage 
2)endoscopic stent 
3)biliodigestive anastomoses

Question 11

Multimodal therapy of pancreatic carcinoma for stages

T1-3 N0-1 M0 OR T3-4 N1 M0

Answer 11

Neoadjuvant radiotherapy and surgery

Surgery and intraoperative 30/30gy dose

Surgery and adjuvant chemotherapy

Surgery+IORT+ percutaneous post op chemo (60gy)
PLUS simultaneously chemo w/ cisplatin & 5fluorouracil