Pancreatic cancer

Pancreatic cancer - Chronic

Definition  

A highly lethal carcinoma , predominantly presenting as ductal adenocarcinoma or less frequently as an islet cell (neuroendocrine) neoplasm. Certain mucinous cystic neoplasms may also progress to adenocarcinoma. It is often associated with advanced disease such as metastatic or locally advanced disease at the time of diagnosis.

 

Resectability of malignant tumor of pancreas  

* CT of abdomen, Region of pancreas: Helical CT is a useful test for staging pancreatic tumors and determining resectability .

 

Suspected and known pancreatic cancer  

* Hepatic function panel: Cancer of the head of the pancreas may be associated with an elevated total bilirubin and alkaline phosphatase and slightly elevated transaminases.

 

Suspected pancreatic cancer  

* CA 19-9 measurement: Elevated carbohydrate antigen (CA) 19-9 can be found in patients with pancreatic carcinoma as well as other pancreatic diseases .

 

Suspected or known biliary obstruction  

* Prothrombin time: Biliary obstruction may lead to vitamin K deficiency and increased prothrombin time.

 

Suspected and known pancreatic cancer  

* Endoscopic ultrasound examination of pancreas: Endoscopic ultrasound can be used for both diagnosis and staging of pancreatic cancer .

 

Pancreatic cancer  

* Staging laparoscopy: Extrapancreatic involvement may be confirmed on laparoscopy with peritoneal washings or visual inspection and biopsy .

 

Medical History  

* Chronic pancreatitis

* Smoking

* Obesity [Obesity - Chronic]

* High sugar diet

* Family History

* Alcohol Use

* Caffeine Use

* Diabetes mellitus [Diabetes mellitus - Chronic]

 

Findings  

* Ascites

* Epigastric pain

* Excessive weight loss

* Hepatomegaly

* Jaundice

* Abdominal mass

 

Tests  

 

Suspected pancreatic cancer  

* CT of abdomen: Spiral CT is the initial test for suspected pancreatic cancer. However, a normal CT does not completely exclude a diagnosis of pancreatic cancer .

 

Suspected pancreatic cancer  

* Abdominal ultrasound: Abdominal ultrasound can detect bile duct dilation, pancreatic duct obstruction, and the presence of a pancreatic head tumor.

 

Suspected and known pancreatic cancer  

* Endoscopic ultrasound examination of pancreas: Endoscopic ultrasound can be used for both diagnosis and staging of pancreatic cancer .

 

Suspected pancreatic cancer  

* Endoscopic retrograde cholangiopancreatography: ERCP may be indicated in patients with suspected pancreatic malignancy, especially if CT findings are not definitive or biliary obstruction is evident .

 

Suspected pancreatic cancer  

* CA 19-9 measurement: Elevated carbohydrate antigen (CA) 19-9 can be found in patients with pancreatic carcinoma as well as other pancreatic diseases .

 

Suspected and known pancreatic cancer  

* Hepatic function panel: Cancer of the head of the pancreas may be associated with an elevated total bilirubin and alkaline phosphatase and slightly elevated transaminases.

 

Suspected pancreatic cancer  

* MRI of abdomen: MRI may be used in patients with suspected pancreatic tumor when CT is contraindicated or not possible for other reasons .

 

Differential Diagnosis  

* Pancreatitis, acute

* Chronic pancreatitis

* Metastasis to pancreas of unknown primary

* Cholestatic hepatitis

* Cholelithiasis with obstruction

* Carcinoma of ampulla of Vater

* Malignant tumor of extrahepatic bile duct

* Tumor of endocrine pancreas

* Abdominal angina

 

Treatment  

 

Drug Therapy  

 

First-line therapy for a patient with pancreatic cancer and metastatic disease  

 

GEMCITABINE HYDROCHLORIDE  

 

GEMCITABINE HYDROCHLORIDE - OXALIPLATIN

 

GEMCITABINE HYDROCHLORIDE - CISPLATIN

 

Second-line drug therapy in a patient with pancreatic cancer and metastatic disease  

 

CAPECITABINE

 

FLUOROURACIL

 

Procedural Therapy  

 

Resectable pancreatic cancer  

* Pancreatectomy: Although surgical resection is the only potentially curative technique for pancreatic cancer, 80% of patients have unresectable disease at presentation .

 

Pancreatic cancer  

* Palliative procedure: Most palliative surgery has become obsolete due to less invasive methods of palliation .

 

Pancreatic cancer  

* Radiation therapy: Radiation therapy has been used in neoadjuvant treatment, adjuvant treatment and in locally advanced disease .

 

Non-Procedural Therapy  

 

Pancreatic cancer patients with an expected survival of less than 6 months  

* Hospice Care

 

Prevention of pancreatic cancer  

* Vitamin D