Pancreatic cancer Flashcards
majority of pancreatic cancer pts present with
unresectable or metastatic dx median survival is 3 to 6 months
indication for chemotherapy for pancreatic cancer is
locally advanced dx that is not surgically resectable
70% of pts with pancreatic cancer can develop symptomatic biliary obstruction which can cause what complication?
how to do we treat biliary obstruction
increases risk for cholangitis
Tx with biliary endoscopic stenting.
Try to relieve obstruction prior to consideration of systemic chemotherapy
Surgical biliary decompression is reserved for people who can’t undergo endoscopic stenting for technical reasons.
whipple procedure
pancreaticoduodenectomy is only for cancer that is confined to the head removes the head of pancreas, gallbladder, part of duodenum and lympho nodes with or without removal of pylorus
requirements for Whipple procedure:
resectable localized within the pancreas without extension far beyond the pancreas
chemotherapy choice for pancreatic cancer
gemcitabine chemotherapy
most pancreatic cancer
has no genetic predisposition median survival is <1 year
Treatment for metastatic pancreatic cancer is
combination of a oxaliplatin, irinotecan, FU, leucovorin (FOLFIRINOX) or combo of nab-paclitaxel and gemcitabine
Algorithm for suspected pancreatic cancer
Why is U/S of abdomen not greatest way to screen for pancreatic cancer?
can miss masses if bowel overlying pancreas or for masses <3 cm small and depends on skill of operator
Best test for pancreatic cancer screen
helical CT abd/pelvis and if mass seen get a EUS w/ FNA
Risk factors for pancreatic cancer
heavy tobacco use, weight loss, abdominal pain, juandice and no gall stones on ultrasound.
treat vipomas with
octreotide.
toursseau syndrome is
migratory thrombosis
also seen in renal cell carcinoma (bag of worms with standing on right side with varicoele)
adenocarcinoma of stomach. -left superclavicular bag.
see on imaging with pancreatic cancer
double duct sign - pancreatic cancer.
