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 Obstructive Jaundice
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 (+) Virchow’s Node
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

11. CA OF THE AMPULLA OF VATER BENIGN LIVER TUMORS PANCREATIC CANCER
PATIENT
CHOLANGIO-CARCINOMA
GB CA
CA OF THE AMPULLA OF VATER
BENIGN LIVER TUMORS
PANCREATIC CANCER
65 Y/O MALE +
JAUNDICE
12mm CBD WITH DILATED INTRAHEPATIC DUCTS
ALT 165IU/ml
ALP 325 mg/dl
TOTAL BILIRUBIN 3mg/dl
PREVIOUS CHOLECYSTECTOMY
SMOKER
DRINKS 2 BOTTLES OF BEER ONCE A WEEK
OBESE
TREATED FOR TB