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home - Pancreas - Pancreatic Cancers - Pancreatic Cancer Diagnosis and Treatment Written by Dr Sebastian Zeki
Knowledge


Knows the presentation investigation and staging of pancreatic
cancer

Recognises the importance of considering and being able to identify
uncommon pancreatic tumours (such as neuroendocrine or
intrapapillary mucinous tuours)

Knows the range of potential therapies and recognises the factors
that make such tumours potentially operable or inoperable

Knows the prevalence and natural history of benign cysts/serous
cystadenoma and potentially malignant cystic lesions

Knows the options for palliative treatment
Skills
Shows ability to sequence investigations appropriately
Understands value of multi-disciplinary team
Recognises the importance of considering possibility that the tumour
is unusual

Behaviours
Communicates effectively within the multi-disciplinary team and with
the patient and their family

Pancreatic Cancer Diagnosis and Treatment

Palliative procedures :Duodenal obstruction-gastrojejunostomy.Analgesia(-a; radiotherapy b; coeliac plexus block).Obstructive jaundice-stenting. USS 70% CT 80% EUS/ERCP 90% brushings 30% CA19-9 90% (low specificity, normal in early stages. Used to assess prognosis and monitor response after neoadjuvant chemotherapy) 1 Presentations:An abdominal mass.Jaundice(if jaundiced needs a stent).Cholangitis. ResectableBorderlineUnresectableMets/Recurrence Good performance Status-Gemcitabine + Poor Performance StatusGemcitabine only If unable to say whether has cancer, may need a repeat biopsy or laparoscopy Good performance Status-Gemcitabine + and radio Poor Performance StatusGemcitabine only Neoadjuvant chemo with stent placement then surgery Surgery then adjuvant chemo (5FU based chemo rad with gem, or chemo alone (gem/5FU/capcitabone) Follow-upCT/ CA19-9 every 4/12 for 2 years then annual is warranted. Salvage with 5FU Salvage with 5FU 3 year Post resection Prognosis:Stage IA-41 % survival.Stage IB-35 % survival.Stage IIA-24 % survival.Stage IIB-14 % survival.Stage III-11 % survival. Treatment of Adenocarcinomas a) Surgery- Whipple’s Borderline resectable lesions:-Those with severe unilateral SMV/ PV impingment.-Those with tumour abutting SMA.-Those with GDA encasement up to origin at hepatic artery.-Those with tumours with limited IVC involvement.-Those with SMV occlusion, if of a short segment, with open vein both segment, with open vein both proximally and distally (If the proximal SMV were occluded upto the portal vein branches then it would be unresectable).Those with colon or mesocolon invasion..-Those with adrenal, colon or mesocolon, or kidney invasion. Unresectable lesions:Those with distant metastases.Those with SMA, coeliac encasement/ SMV/portal occlusion.Those with Aortic, Inferior vena cava (IVC) invasion or encasement.Those with invasion of SMV below transverse mesocolon.Those with distant metastases.Those with SMA, celiac, hepatic encasement/SMV/portal occlusion.Those with Aortic invasion.Those with distant metastases.Those with SMA, celiac encasement.Those with rib, vertebral invasion.Metastases to lymph nodes beyond the field of resection should beconsidered unresectable. Resectable lesions:-Those with distant mets.-Those with a clear fat plane around coeliac and SMA.-Those with a patent SMV/ portal vein. Tail Head/ Body Nodal status Tail Body Head Resectability Tests Sensitivity Written by Dr Sebastian Zeki

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