Pancreatitic Cancer Flashcards
What are the pathological types of pancreatitic cancer?
Adenocarcinoma 90%
Neuroendoncrine (PanNET)
Lymphoma
Sarcoma
How do pancreatitic Ca’s present?
Obstructive jaundice
Non-specific epigastric/back pain, fatigue, anorexia, weightloss, malabsorption
What molecular factors lead to late presentation and difficulty treating?
Aggressive biology
Desmoplastic stroma
Low immunogenicity
Which cancer marker is specific for pancreatitic Ca?
Ca19-9
What type of tissue is yielded from ERCP?
Generally poor
- cell scrapings for cytology
How is localised pancreatitic cancer Mx?
Resectable = surgery + adjuvant chemo
Borderline resectable = neo-adjuvant chemo then surgery
Unresectable (locally advanced, T4) = Unclear, usually chemo
How is metastatic disease managed?
Chemo +/- radiotherapy
What is the alternative surgical procedure to the Whipple’s? How does it differ?
Pylorus-preserving pancreaticoduodenectomy (PPPD)
Avoids removal of stomach or pylorus
What is resected in a Whipple’s?
Bile duct Distal stomach Head of pancreas Duodenum Gallbladder
What adjuvant chemo regimen is used in pancreatitic Ca?
MPACT trial: Nanoalbumin bound (nab)-paclitaxel + gemcitibine
In more fit patient - FOLFIRINOX - 5FU, oxaliplatin, and irinotecan
What are some risk factors for pancreatitic Ca?
Smoking Long-standing DM Nonheritary and chronic pancreatitis Obesity, inactivity Non-O blood group
What are the SE’s of paclitaxel?
Neuropathy
Diarrhoea
When can PARP inhibitors be used?
In BRCA positive patients
Which genetic syndromes are associated with pancreatitic Ca? (approximate risk)
Hereditary pancreatitis - 50
Peutz-Jeghers - 30-40
Familial atypical multiple mole and melanoma syndrome - 10-20
Hereditary non-polyposis colon cancer - 4
BRCA1, BRCA 2, PALB2
What genetic mutation is associated with pancreatitic Ca
KRAS >90%
