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Pancreatic Cancer
Jason Ryan, MD, MPH
Pancreatic Cancer
• Usually adenocarcinoma (75% of cases)
• “Exocrine pancreatic cancer”
• Other types: neuroendocrine cancers
• More common at head of pancreas
• Poor prognosis AfraTafreeh.com
• Usually metastatic at presentation
• Most patients die from their cancer
• 5-year survival node-positive: 10%
• 5-year survival node-negative: 25%
BruceBlaus
AfraTafreeh.com
Pancreatic Cancer
Jaundice
• Often causes vague abdominal pain, weight loss
• Classic presentation is “painless jaundice”
• Early tumors at head obstruct bile flow
• No pain due to absence of inflammation
• May see other signs of pancreatic-biliary obstruction
• Dark urine
• Steatorrhea
James Heilman, MD
Courvoisier’s Sign
• Classic physical exam finding for pancreatic cancer
• Enlarged, non tender gallbladder plus jaundice
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Shuttertock
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Trousseau’s Syndrome
• Classic finding of pancreatic cancer
• Migratory superficial thrombophlebitis
• Migratory: comes/goes in different locations
• Superficial: below skin
• Thrombophlebitis : thrombosis/inflammation of veins
• Redness and induration on skin that migrates
• Due to hypercoagulable state
S Bhimji MD/Creative Commons
Pancreatic Cancer
Risk Factors
• Age > 50 years old
• Smoking Strongest Risk Factors
• Diabetes
• Chronic pancreatitis (> 20 years)
• NO strong association with alcohol
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• Studies have shown mixed findings
• Some data that heavy drinking (> 3/day) increases risk
Gapstur S. et al. Association of Alcohol Intake With Pancreatic Cancer Mortality in Never Smokers Arch
Intern Med. 2011;171(5):444-451.
AfraTafreeh.com
Pancreatic Cancer
Diagnosis
• Common first test: abdominal ultrasound
• Identifies dilated common bile duct
• Good sensitivity for larger tumors (>3cm)
• Can miss smaller tumors
• Most sensitive test: abdominal CT scan
Public Domain
BRCA2 Mutations
• BRCA1/BRCA2 genes → DNA repair proteins
• Gene mutations associated with breast/ovarian cancer
• BRCA2 mutations also associated with pancreatic CA
• More common with Ashkenazi Jewish ancestry
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Public Domain
AfraTafreeh.com
Pancreatic Cancer
Tumor Markers
• CA-19-9
• Cancer-associated antigen 19-9
• Specificity 68-92%
• Sensitivity 70-92% (may be negative in smaller tumors)
• Not useful for diagnosis
• Can be followed after treatment
• CEA
• Can be elevated in pancreatic cancer
• Poor sensitivity/specificity
• Largely replaced by CA-19-9
Pancreatic Cancer
Treatment
• Surgery
• For disease confined to the pancreas
• Head: Whipple procedure (pancreaticoduodenectomy)
• Tail: distal pancreatectomy and splenectomy
Whipple Procedure
• Chemotherapy
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• Common bile duct stenting
• Palliative to relieve jaundice
Cancer Research UK
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Pancreatic Neuroendocrine Tumors
NETs or Islet Cell Tumors
• Insulinomas
• Glucagonomas
• Gastrinomas
• Somatostatinomas
• VIPomas
BruceBlaus
