Pancreatic Cancer

Why does pancreatic cancer have the highest rate of mortality?

• late diagnosis

• aggressive growth

• ability to metastasize

What are the type of pancreatic cancer?

1. Adenocarcinoma (develops in the pancreatic ducts, also known as exocrine tumors) - most common

2. Tumors in hormone producing cells (endocrine tumors) - more rare

What are the exocrine functions of the pancreas?

• Insulin production

• Enzyme productions that help digestion (lipase)

What are the signs and symptoms of pancreatic cancer?

• Usually none until cancer is advanced

• Upper abdominal pain that may radiate to your back

• Jaundice

• Anorexia

• Weight loss

• Depression

• Diarrhea, pale and smelling stools that float (fatty)

• Pain with eating

• Indigestion not responding to prescribed medication

• New onset diabetes not associated with weight gain

• Fatigue

What would you ask if a patient presented with upper abdominal pain?

“Is it associated with eating?”

What are the risk factors associated with pancreatic cancer?

• Smoking

• Diabetes

• Being overweight or obese (associated with type 2 DM)

• Personal or family history or chronic inflammation of the pancreas (pancreatitis)

• Personal or family history of pancreatic cancer

• Family history of genetic syndromes that can increase cancer risk, including a BRCA 2 gene mutation and others

• Older age: pancreatic cancer occurs most often in older adults; most people are diagnosed with pancreatic cancer when they are in their 7-s and 80s (>65!)

• Pancreatic cancer occurs more frequently in African American than Caucasians

How do we screen for pancreatic cancer?

• Ultrasound

• CT scan

• MRI

• ERCP

• Percutaneous trans-hepatic cholangiography (PTC)

• Endoscopic ultrasound (EUS)

How do we stage pancreatic cancer?

• Serum tumor marker screening

• Laparoscopy for abdominal metastases

• Chest x-ray for lung metastases

• CT scan

• MRI

• PET scan

• Bone scan

What does it mean if pancreatic cancer is resectable?

All the tumor nodules can be removed

What does it mean if pancreatic cancer is locally advanced?

The tumor can no longer be removed with surgery because the cancer has spread to tissues around the pancreas or into blood vessels

What does it mean if pancreatic cancer is metastatic?

The cancer has spread to distant organs, such as the lungs and the liver.

Whipple procedure

A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin

BIG RECOVERY!!

PERSON HAD TO BE DX WITH METASTATIC CANCER

Total pancreatectomy

This operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes

Distal pancreatectomy

The body and the tail of the pancreas and usually the spleen are removed

Palliative surgery

Relieve symptoms if cancer is advanced

Can’t save life but increase quality of life

What are the complications of pancreatic cancer?

• Jaundice from blocked bile duct

• Pain

• Bowel obstruction from mets of the duodenum

• Anorexia

• Death probably even if diagnosed in early stages

How can we prevent pancreatic cancer?

• Stop smoking

• Maintain a healthy weight

• Exercise at least 30 mins per day

• Eat a healthy diet

Colorectal cancer evolution

• Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps

• Over time, some of these may become colon cancers

Could we stage a polyp?

Yes! It would be in situ!

This prognosis is good - we got it before any damage was done!

What are the 3 types of polyps?

1. Adenomas

2. Hyperplastic polyps

3. Inflammatory polyps

Adenomas

These polyps have the potential to become cancerous and are usually removed during screening tests such as flexible sigmoidoscopy or colonoscopy.

Hyperplastic polyps

These polyps are rarely, if ever, a risk factor for colorectal cancer.

Inflammatory polyps

These polyps may follow a bout of ulcerative colitis. Some inflammatory polyps may become cancerous, so having ulcerative colitis increases your overall risk of colon cancer.

If someone presents wit hemorrhoids, what should we ask first?

• Constipated?

• Pain?

• Have them before?

If there is blood in a patient’s stool but they are under 65, what is more likely - hemorrhoids or cancer?

Hemorrhoids! Colon cancer is rare under the age of 65. Looking at age is a big thing!!!

Signs and symptoms of colon cancer

• A change in bowel habits, including diarrhea or constipation or a change in the consistency of stool for more than a couple of weeks

• Rectal bleeding or blood in your stool

• Persistent abdominal discomfort, such as cramps, gas, or pain

• Abdominal pain with a bowel movement

• A feeling that your bowel doesn’t empty completely (this is because there might be a tumor that nerves are thinking is stool)

• Weakness or fatigue

• Unexplained weight loss

Risk factors for colorectal cancer

• AGE >50 years old is #1 nonmodifiable risk factor

• Personal history of cancer on any part of the body

• Hx of inflammatory bowel disease

• Genetic syndrome

• Family history of polyps/cancer

• Low fiber/high fat/high calorie diet (stool harder to ass, less frequent, irritating to colon; fat slows down digestion; being overweight increases risk for cancer)

• Sedentary lifestyle

• Diabetes

• Ohesity

• Alcohol use

• Excess growth hormone

• History of radation therapy (can causeburns and other damage to surroudning cells → DNA damage increases risk for recurring cancer)

Screening and diagnosis of colorectal cancer

• High-sensitivity fecal occult blood tests (FOBT)

• Stool DNA tests (analyzes DNA marker present in colon cancer; good for low risk people to see if they need a colonoscopy)

• Flexible sigmoidoscopy

• Barium enema

• Colonoscopy

• Virtual colonoscopy

Screening recommednations for colorectal cancer

The American Cancer Society 2018 guideline for colorectal cancer screening recommends that average-risk adults aged 45 years and older undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) exam, based on personal preferences and test availability. As a part of the screening process, all positive results on non- colonoscopy screening tests should be followed up with timely colonoscopy.

Colonoscopy recommended >50 years old

How to decrease the risk of colorectal cancer

• High fiber diet

• Low fat (low saturated fat) diet

• Diet high in vitamin B-6, calcium, folic acid, and magnesium

• Limit alcohol

• Exercise

• Don’t smoke