Pancreatic Cancer
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Rismauli doloksaribu
pancreatic cancer has one of the poorest prognoses. Because pancreatic cancer often grows and spreads long before it causes any symptoms, only about 5% of patients are still alive five years after diagnosis. (<5% 5yr surv) As cause of cancer mortality: 4th
Diagnosed with stage IV pancreatic cancer Jan 2008 Died Sept 14, 2009
Diagnosed Pancreatic cancer in 2004, died in 2011
• Smoking • Age, gender • Obesity • Diet – high fat, low fibre • Chronic pancreatitis • Family history – BRCA2 • Β-napthylamine
Smoking, Familial pancreatitis, BRCA2, HNPCC, ? Chemical exposures
Blood Test: Liver function test, include bilirubin Tumor marker (CA 19-9 or CEA) CT best for staging EUS for biopsy Laparoscopy
initially to determine if there is peritoneal involvement not seen on CT
The degree of elevation post op is predictive of long term survival CA19-9 is elevated by biliary obstruction per se and is elevated in other cancers (e.g., gastric, bladder…)
Painless obstructive jaundice (pancreatic head tumors -2/3) Abdominal pain Anorexia, weight loss Trousseau’s sign of malignancy Depression diabetes
Liver Peritoneum Lung Adrenal Bone Rarely CNS
Most common
Resectable disease
Stages I-II (20%)
Surgery Adjuvant chemotherapy
Adjuvant radiation
Surgery only curative modality but only 5-20% are resectable
Choiced : Chemotherapy
Gemcitabine has modest survival benefit compared to 5fu; approved mainly for quality of life benefits (wt gain, decreased pain): ◦ med surv 5.65 mos for gem and 4.41 for 5fu; ◦ 1yr surv 18%vs 2%
Sultana, A. et al. J Clin Oncol; 25:2607-2615 2007
Chemo is better than supportive care in terms of survival Gemcitabine better than 5FU
Folfirinox regimen ◦ Nearly 3.6 month survival benefit compared to gemcitabine alone
Adding Abraxane (taxol bound to albumin “nanoparticle”) ◦ Survival benefit about 1.8 months more than gemcitabine alone
Take home points • Usually present at late stage
Jaundice
Survival
• Surgery is the only chance for cure • Resectable followed by adjuvant therapy • Metastatic diss may benefit from chemotherapy instead of other palliative treatments
pancreatic cancer has one of the poorest prognoses. Because pancreatic cancer often grows and spreads long before it causes any symptoms, only about 5% of patients are still alive five years after diagnosis. (<5% 5yr surv) As cause of cancer mortality: 4th
Diagnosed with stage IV pancreatic cancer Jan 2008 Died Sept 14, 2009
Diagnosed Pancreatic cancer in 2004, died in 2011
• Smoking • Age, gender • Obesity • Diet – high fat, low fibre • Chronic pancreatitis • Family history – BRCA2 • Β-napthylamine
Smoking, Familial pancreatitis, BRCA2, HNPCC, ? Chemical exposures
Blood Test: Liver function test, include bilirubin Tumor marker (CA 19-9 or CEA) CT best for staging EUS for biopsy Laparoscopy
initially to determine if there is peritoneal involvement not seen on CT
The degree of elevation post op is predictive of long term survival CA19-9 is elevated by biliary obstruction per se and is elevated in other cancers (e.g., gastric, bladder…)
Painless obstructive jaundice (pancreatic head tumors -2/3) Abdominal pain Anorexia, weight loss Trousseau’s sign of malignancy Depression diabetes
Liver Peritoneum Lung Adrenal Bone Rarely CNS
Most common
Resectable disease
Stages I-II (20%)
Surgery Adjuvant chemotherapy
Adjuvant radiation
Surgery only curative modality but only 5-20% are resectable
Choiced : Chemotherapy
Gemcitabine has modest survival benefit compared to 5fu; approved mainly for quality of life benefits (wt gain, decreased pain): ◦ med surv 5.65 mos for gem and 4.41 for 5fu; ◦ 1yr surv 18%vs 2%
Sultana, A. et al. J Clin Oncol; 25:2607-2615 2007
Chemo is better than supportive care in terms of survival Gemcitabine better than 5FU
Folfirinox regimen ◦ Nearly 3.6 month survival benefit compared to gemcitabine alone
Adding Abraxane (taxol bound to albumin “nanoparticle”) ◦ Survival benefit about 1.8 months more than gemcitabine alone
Take home points • Usually present at late stage
Jaundice
Survival
• Surgery is the only chance for cure • Resectable followed by adjuvant therapy • Metastatic diss may benefit from chemotherapy instead of other palliative treatments
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