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    Pancreatic Cancer: Aziz Ahmad, MD Surgical Oncology Mills-Peninsula Hospital April 23, 2011

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    mywifenoor1983
    Pancreatic cancer has a poor prognosis overall due to late stage diagnosis in most cases. The pancreas has a rich blood and lymphatic supply allowing for early spread. Surgery offers the only chance for cure, but is only possible in 15-20% of cases where the cancer is localized to the pancreas. Even with surgery and adjuvant chemotherapy, the 5-year survival rate is only 20-30% as recurrence is common. Improved imaging technology and a high index of suspicion may allow for earlier detection when surgical resection offers the best chance for cure or prolonged survival.

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    Pancreatic Cancer: Aziz Ahmad, MD Surgical Oncology Mills-Peninsula Hospital April 23, 2011

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    mywifenoor1983
    140 views18 pages
    Pancreatic cancer has a poor prognosis overall due to late stage diagnosis in most cases. The pancreas has a rich blood and lymphatic supply allowing for early spread. Surgery offers the only chance for cure, but is only possible in 15-20% of cases where the cancer is localized to the pancreas. Even with surgery and adjuvant chemotherapy, the 5-year survival rate is only 20-30% as recurrence is common. Improved imaging technology and a high index of suspicion may allow for earlier detection when surgical resection offers the best chance for cure or prolonged survival.

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    Pancreatic cancer has a poor prognosis overall due to late stage diagnosis in most cases. The pancreas has a rich blood and lymphatic supply allowing for early spread. Surgery offers the only chance for cure, but is only possible in 15-20% of cases where the cancer is localized to the pancreas. Even with surgery and adjuvant chemotherapy, the 5-year survival rate is only 20-30% as recurrence is common. Improved imaging technology and a high index of suspicion may allow for earlier detection when surgical resection offers the best chance for cure or prolonged survival.

    Copyright:

    Attribution Non-Commercial (BY-NC)
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    140 views18 pages

    Pancreatic Cancer: Aziz Ahmad, MD Surgical Oncology Mills-Peninsula Hospital April 23, 2011

    Uploaded by

    mywifenoor1983
    Pancreatic cancer has a poor prognosis overall due to late stage diagnosis in most cases. The pancreas has a rich blood and lymphatic supply allowing for early spread. Surgery offers the only chance for cure, but is only possible in 15-20% of cases where the cancer is localized to the pancreas. Even with surgery and adjuvant chemotherapy, the 5-year survival rate is only 20-30% as recurrence is common. Improved imaging technology and a high index of suspicion may allow for earlier detection when surgical resection offers the best chance for cure or prolonged survival.

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    Pancreatic Cancer

    Aziz Ahmad, MD Surgical Oncology Mills-Peninsula Hospital April 23, 2011

    Statistics
    10th most common cancer
    4th leading cause of cancer death

    Statistics
    80% of cases are adenocarcinomas from exocrine pancreas
    Less common exocrine tumors include:
    IPMN Mucinous cystadenocarcimomas

    Islet cell tumors


    Insulin, glucagon, VIP, sandostatin, gastrin, nonsecreting

    Most common in black males Median age of diagnosis is 70

    Statistics
    Risk Factors:
    Smoking Low Vegtables & Fruits High red meat High sugar sweetened drinks Chronic pancreatitis (especially hereditary) Diabetes Obesity Genetic (5-10%)
    Family history, Puetz-Jerghers, HNPCC, FAP, AtaxiaTelangiectasia, Hereditary Pancreatitis, FAMMM-PC

    Presentation
    Nonspecific symptoms
    Tumors of body and tail (25%)
    Pain and weight loss

    Tumors of the Head (75%)


    Jaundice, steatohrrea, weight loss, Couvoirsiers sign, pain

    Labs
    Increased LFTs, elevated CA19-9

    Imaging
    Ultrasound
    Bile duct distension Mass

    CT scan with IV contrast


    Quality of imaging continues to improve Triple phase CT (pancreas protocol) 90% accurate at finding lesions

    Endoscopic ultrasound
    Help find lesions not seen on CT Help determine resectability Excellent way to get biopsy

    ERCP
    Therapeutic as well as diagnostic

    Treatment
    Needs to be multimodal
    Primary care, radiology, gastroenterology, surgery, & oncology

    Surgery is the only cure


    Cure only in those with complete resections
    Otherwise outcome is poor with surgery

    Treatment
    Finding lesions early (hardest job)
    High index of suspicion by primary care

    Modern CT technology Gastroenterologist with specialized skill in ERCP and EUS Surgeons with experience in pancreatic surgery Radiation/medical oncology up to date with standard of care and knowledge of any promising clinical trials

    What is resectable?
    Tumors localized to pancreas
    15-20% of patients

    Locally advanced disease in patients with vascular involvement of less than 50% of portal vein Or lymph node spread that is limited
    10-15% Resection contraindicated in patients:
    >50% involvement of portal vein Invasion or encasement of SMA (or hepatic artery)

    Non Surgical Candidates


    Palliative chemoradiation Clinical trials
    Median survival is about 8 months

    Palliative endoscopic or surgical procedures 5-10% locally advanced patients not initially surgical candidates can be downstaged

    General Survival Data


    Overall prognosis seems dismal 70-80% of patients present as inoperable due to metastatic disease or locally advanced disease
    Median survival only 4-6 months

    20-30% are operable with localized or resectable locally advanced disease


    Successful operation can give five year survivals from 20-30%

    Surgical Procedures
    Tumors of the Body and Tail
    Laparoscopic distal pancreatectomy
    Removal of body & tail of pancreas spleen

    Surgical Procedures
    Head of the pancreas: Whipple Procedure
    Removal of:
    Distal stomach Duodenum and proximal jejunem Head of pancreas Gallbladder and common bile duct

    Complications
    Whipple Procedure
    bleeding Gastroparesis Pancreatic duct leak Bile duct leak Diabetes malabsorption

    Distal pancreatectomy
    Bleeding Pancreatic duct leak Malabsorption diabetes

    Complications
    Particularly Whipple procedure thought to have poor surgical outcomes
    Mills-Peninsula experience in the last 40 Whipples:
    5% 60 day mortality

    Even in patients that recur after 2-3 years, quality of life is excellent before symptoms of disease return

    Adjuvant Treatment
    Most patients go on to get adjuvant treatment
    Gemcitibine based chemotherapy Radiation to the surgical bed

    Even with this 70-80% of patients recur

    Why Does it Recur?


    Pancreas with rich vascular and lymphatic supply
    Early lymph node spread
    Microscopic at the time of surgery

    Currently best chemo with only 25-30% response rate

    Conclusion
    So at this time the best answer is to catch the disease early In those that you can detect disease early, all hope is not lost With an operation, you not only give a chance for cure, but you give hope

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