FNA - adenocarcinoma Which tumor marker will be elevated ? Are there other histologic types of pancreatic malignancies?
What are the most common complaints of patients with pancreatic cancer?
What are the most common complaints of patients with pancreatic cancer? What are the most common physical findings in patients with pancreatic cancer? Jaundice Abdominal pain Back pain - esp. at night Weight loss Loss of appetite “New diabetes mellitus” “No symptoms” for a long period
What is considered resectable pancreatic cancer?
Pancreatic cancer - Presentation Extent of disease at diagnosis: –Resectable 20% –Locally advanced unresectable 40% –Metastatic 40%
Pancreatic Cancer - Prognosis Median survival –Metastatic disease- 3-6 months –Locally advanced, unresectable 8-12 months
Pancreatic Cancer – Surgery Theoretically - the only curative treatment Only 15-20% undergo pancreatectomy Principles: –Laparatomy should be therapeutic, NOT diagnostic –Resectability should be determined preoperatively –Palliative laparotomy should be avoided when possible
Pathologic report Moderately differentiated adenocarcinoma of the pancreatic head Tumor size - 2.2 cm Invasion of duodenal wall Surgical margins free of disease No vascular invasion 14 regional lymph nodes - free of tumor
What is the staging of pancreatic cancer in our patient ?
Pancreatic Cancer - Adjuvant Chemo + RT 12.6 m 54 17 m 60EORTC 11 m 119 19 m 333Sohn 11 m 22 20 m 21Kalser 13.5 5319.5 m 120Yeo et al n Median survival n Surgery S+RT+5FUStudy Median survival
Pancreatic Cancer- Adjuvant Chemo + RT – Median Survival in Months
After 2 years our patient develops ascites and liver metastases. What is the best approach now? Will chemotherapy improve the quality of the remaining life of this patient? Will chemotherapy prolong life? Which chemotherapy is recommended?