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PANCREATIC CANCER

PANCREATIC CANCER

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PANCREATIC CANCER

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  1. PANCREATIC CANCER

  2. PANCREATIC CANCER • DUCTAL ADENOCARCINOMAS (90%) • ISLET CELL TUMORS • NEUROENDOCRINE TUMORS • Head of the pancreas – frequent site

  3. PANCREATIC CANCER • 72 years old – median age of diagnosis • 65-84 years old – peak incidence • Males > Females • Risk Factors: • Cigarette Smoking, Obesity, Non-hereditary Chronic Pancreatitis • Environmental Factors (diet, coffee), previous partial gastrectomy or cholecystectomy and H. pylori

  4. CLINICAL FEATURES • Common presenting symptoms • Pain • More of a problem with lesions in the body or tail • Dull ache in the upper abdomen radiating to the back and may characteristically improve upon leaning forward • Intermittent and may worsen with meals • Obstructive Jaundice • pruritus, pale stools and dark urine • Weight loss • Anorexia, early satiety, malabsorption or diarrhea/steatorrhea • Anorexia

  5. PHYSICAL FINDINGS • (+) Courvoisier’s sign • Palpable, nontender gallbladder • (+) Virchow’s Node • Advanced Disease • Abdominal Mass, Hepatomegaly, Splenomegaly, Ascitis

  6. DIAGNOSTIC PROCEDURES • Ultrasound • CT scan • Show pancreatic mass, dilatation of the biliary system or pancreatic duct, distal spread to the liver, regional lymph nodes or peritoneum • ERCP • Stricture or obstruction, obtain brushings of a stricture for cytology or for placing stents • Endoscopic Ultrasound • Small lesions (<2-3cm), local staging • MRCP • Defines anatomy of the pancreatic duct and biliary tree • FDG-PET • Excluding occult distal metastasis

  7. CA 19-9 • Serum Marker • 80-90% sensitivity and specificity • Suggestive of the diagnosis of pancreatic cancer • May be elevated in patients with jaundice without pancreatic cancer • Prognostic impilcations • Very high levels with inoperable disease • Serial evaluation is useful for monitoring response to treatment • Detecting recurrence in patients with completely resected tumors

  8. TREATMENT • Symptom management • Advanced Pancreatic Cancer • With metastatic or locally advanced inoperable disease and are the majority with newly diagnosed disease • Endoscopic biliary or duodenal stenting • Intestinal bypass surgery • Deoxycytidine analogue Gemcitabine • Single agent 1,000 mg/m2 weekly for 7 weeks followed by 1 week rest then weekly for 3 weeks every four weeks thereafter • Median survival – 6 months, 12 months (18%)

  9. TREATMENT • Operable Disease • Complete surgical resection (Stage I or II) with distant metastases excluded by prior CT is potentially curative • Lymph node-negative disease, smaller tumors (<3cm) negative resection margins and well-differentiated tumors • Surgery preceded by laparoscopy • To exclude peritoneal metastases

  10. TREATMENT • WHIPPLE PROCEDURE/ Pancreaticoduodenectomy • Standard operation for cancers of the head or uncinate process of the pancreas. • Involves resection of the pancreatic head, duodenum, 1st 15cm of jejunum, common bile duct, and gallbladder and a partial gastrectomy, with the pancreatic and biliary anastomosis placed 45 – 60 cm proximal to the gastrojejunostomy