pancreatic cancer

What is the rank of pancreatic cancer as a cause of cancer deaths in the US?

Pancreatic cancer is the fourth leading cause of cancer deaths in the US. Summary 1

What age group is typically affected by pancreatic cancer?

Pancreatic cancer typically affects older individuals in the sixth to eighth decades of life. Summary 2

What are the underlying risk factors for pancreatic cancer?

Underlying risk factors include smoking, obesity, heavy alcohol consumption, and chronic pancreatitis. Summary 3

What is the most common type of pancreatic carcinoma?

Pancreatic carcinomas are mostly ductal adenocarcinomas. Summary 4

Where are pancreatic carcinomas frequently located?

Pancreatic carcinomas are frequently located in the pancreatic head. Summary 5

Why is pancreatic cancer often diagnosed at an advanced stage?

The disease is commonly diagnosed at an advanced stage because of the late onset of clinical features. Summary 6

What are some typical clinical features of advanced pancreatic cancer?

Typical clinical features of advanced pancreatic cancer include epigastric pain, painless jaundice, and weight loss. Summary 7

Where does pancreatic cancer commonly metastasize?

Pancreatic cancer commonly metastasizes to the liver. Summary 8

What is the usual approach to pancreatic cancer treatment?

Treatment is often palliative as surgical resection is only possible in approximately 20% of cases. Summary 9

What is the most commonly used surgical technique for pancreatic cancer?

The most commonly used surgical technique is the pancreaticoduodenectomy (Whipple procedure). Summary 10

What is the range of five-year survival rates for pancreatic cancer?

Five-year survival rates range from 3-40% depending on the extent, spread, and resectability of the tumor. Summary 11

What can small pancreatic lesions discovered on imaging represent?

Small pancreatic lesions can represent benign, precancerous, or malignant lesions. Summary 12

Is routine screening recommended for pancreatic cancer?

Screening is not routinely performed but is recommended for select high-risk individuals. Summary 13

What is the typical age range for onset of pancreatic cancer?

60-80 years. Epidemiology 14

What percentage of new cancers in the US does pancreatic cancer account for?

∼ 3% of all new cancers in the US. Epidemiology 15

What were the estimated new cases of pancreatic cancer in the US in 2020?

57,600 individuals (♂ > ♀). Epidemiology 16

What percentage of cancer deaths in the US does pancreatic cancer account for?

∼ 8% of all cancer deaths in the US. Epidemiology 17

Which high-risk groups are predisposed to pancreatic cancer?

African Americans and Individuals of Jewish ancestry. Epidemiology 18

What is the strongest exogenous risk factor for pancreatic cancer?

Smoking is the strongest exogenous risk factor. Etiology 19

How long is chronic pancreatitis a risk factor for pancreatic cancer?

Especially when present for more than 20 years. Etiology 20

What are other exogenous risk factors for pancreatic cancer?

High alcohol consumption, type 2 diabetes mellitus, obesity, occupational exposure to certain chemicals, and possibly H. pylori and Hepatitis B infections. Etiology 21

What are endogenous risk factors for pancreatic cancer?

Age > 50 years, inherited genetic syndromes, Familial atypical multiple mole melanoma (FAMMM) syndrome, Hereditary breast and ovarian cancer syndrome, HNPCC, Von-Hippel-Lindau syndrome, Neurofibromatosis type 1, Multiple endocrine neoplasia type 1, Familial pancreatic carcinoma, Hereditary pancreatitis, and Peutz-Jeghers syndrome. Etiology 22

Are early symptoms common for pancreatic cancer?

In most cases, there are no early symptoms suggestive of pancreatic cancer. Clinical features 23

What are some constitutional symptoms of pancreatic cancer?

Poor appetite, weight loss, weakness. Clinical features 24

What are some gastrointestinal symptoms of pancreatic cancer?

Belt-shaped epigastric pain, nausea, malabsorption, diarrhea, jaundice, pale stools, dark urine, and pruritus. Clinical features 25

What is the Courvoisier sign?

Enlarged, nontender gallbladder and painless jaundice. Clinical features 26

What glucose intolerance is associated with pancreatic cancer?

Impaired glucose tolerance (rarely). Clinical features 27

What hypercoagulability-related symptoms are seen in pancreatic cancer?

Trousseau syndrome (superficial thrombophlebitis) and other thromboses (e.g. phlebothrombosis, splenic vein thrombosis). Clinical features 28

What is Trousseau syndrome?

Superficial thrombophlebitis, often migratory, associated with pancreatic cancer. Clinical features 29

What is the classic "3P's" associated with thrombosis of unknown origin?

Pancreatic cancer, pulmonary carcinoma, and prostatic carcinoma. Clinical features 30

Is the differential diagnosis between pancreatic cancer and chronic pancreatitis easy?

Differential diagnosis is difficult since carcinoma may be accompanied by pancreatitis. Clinical features 31

When is pancreatic cancer usually diagnosed?

In the majority of instances, pancreatic cancer is diagnosed in symptomatic patients once it has already spread. Diagnosis 32

What can pancreatic lesions identified early be?

If identified at an early stage (e.g., as an incidentaloma), lesions may be resectable. Diagnosis 33

What guides initial testing for pancreatic cancer?

Initial testing is guided by clinical presentation. Diagnosis 34

Which imaging is often the initial recommended test for pancreatic cancer, especially if jaundice is present?

Ultrasound abdomen. Diagnosis 35

When is a CT abdomen performed in suspected pancreatic cancer?

To confirm ultrasound findings, to evaluate spread, and to determine resectability, or as initial imaging for abdominal pain/weight loss. Diagnosis 36

When is an MRI abdomen used for pancreatic cancer?

As an alternative if CT is contraindicated. Diagnosis 37

What are the imaging findings of pancreatic adenocarcinoma?

Poorly defined, hypodense/hypoechoic, hypovascular mass, Double-duct sign, pancreatic head mass with cystic components. Diagnosis 38

What is the double-duct sign?

Dilation of the common bile duct and pancreatic duct due to tumors of the pancreatic head blocking bile drainage. Diagnosis 39

Are laboratory findings specific to pancreatic cancer?

Laboratory findings are variable and nonspecific but may show abnormalities. Diagnosis 40

What routine laboratory tests are obtained for pancreatic cancer?

CBC, BMP, pancreatic enzymes, liver chemistries, and liver function parameters. Diagnosis 41

When do increased lipase and/or cholestatic enzymes typically occur in pancreatic cancer?

Due to the presence of obstructive tumors (typically of the pancreatic head). Diagnosis 42

When is an EUS used for pancreatic cancer?

To confirm the diagnosis and determine resectability when other studies are inconclusive. Diagnosis 43

What can an EUS be combined with for pancreatic cancer diagnosis?

FNA for tissue sampling. Diagnosis 44

Why is tissue sampling important in pancreatic masses or cysts?

To differentiate pancreatic cancer from pancreatitis and other malignant/nonmalignant lesions. Diagnosis 45

What are alternatives to EUS guided tissue biopsy?

Percutaneous ultrasound or CT guided biopsy. Diagnosis 46

When is an MRCP typically used for pancreatic cancer?

To rule out choledocholithiasis and assess if biliary decompression is indicated. Diagnosis 47

When is an ERCP usually used for pancreatic cancer?

When biliary decompression is indicated. Diagnosis 48

Are tumor markers recommended for diagnosis or screening of pancreatic cancer?

No, tumor markers are not recommended for diagnosis or screening. Diagnosis 49

What is CA 19-9 used for in pancreatic cancer?

Prognostic marker and marker of cancer progression and response to therapy. Diagnosis 50

What is CEA used for in pancreatic cancer?

May be used as an adjunct to CA 19-9 as a diagnostic and prognostic marker. Diagnosis 51

What is the standard staging system used for pancreatic cancer?

American Joint Committee for Cancer (AJCC) TNM classification. Staging 52

What is T1 in pancreatic cancer staging?

Maximum tumor diameter ≤ 2 cm. Staging 53

What is T2 in pancreatic cancer staging?

Maximum tumor diameter > 2 cm and ≤ 4 cm. Staging 54

What is T3 in pancreatic cancer staging?

Maximum tumor diameter > 4 cm. Staging 55

What is T4 in pancreatic cancer staging?

Tumor involves the celiac axis, common hepatic artery, and/or superior mesenteric artery. Staging 56

What is N0 in pancreatic cancer staging?

No regional lymph node involvement. Staging 57

What is N1 in pancreatic cancer staging?

Involvement of 1-3 regional lymph nodes. Staging 58

What is N2 in pancreatic cancer staging?

Involvement of ≥ 4 regional lymph nodes. Staging 59

What is M0 in pancreatic cancer staging?

No distant metastases. Staging 60

What is M1 in pancreatic cancer staging?

Distant metastases. Staging 61

What is Stage IA pancreatic cancer?

T1, N0, M0. Staging 62

What is Stage IB pancreatic cancer?

T2, N0, M0. Staging 63

What is Stage IIA pancreatic cancer?

T3, N0, M0. Staging 64

What is Stage IIB pancreatic cancer?

Up to T3, N1, M0. Staging 65

What is Stage III pancreatic cancer?

Up to T3, N2, M0 or T4, any N, M0. Staging 66

What is Stage IV pancreatic cancer?

Any T, any N, M1. Staging 67

Where are most pancreatic cancers located?

Pancreatic head (65%). Pathology 68

What percentage of pancreatic cancers are in the body and tail?

15% of cases. Pathology 69

What percentage of pancreatic cancers are diffuse?

20% of cases. Pathology 70

What cell origin are pancreatic exocrine tumors?

Pancreatic acini and ducts. Pathology 71

What is the most common type of pancreatic cancer?

Ductal adenocarcinoma (95%). Pathology 72

What are some less common pancreatic cancers?

Acinar adenocarcinoma and Mucinous cystadenocarcinoma. Pathology 73

What cell origin are pancreatic endocrine tumors?

Islet cells. Pathology 74

What are some differential diagnoses for pancreatic cancer?

Focal pancreatitis, pancreatic pseudocyst, metastasis, ampullary cancer, lipoma. Differential diagnoses 75

What is the resectability rate of pancreatic tumors at presentation?

Approximately 10-20% of patients present with resectable tumors. Treatment 76

What percentage of patients present with borderline resectable disease?

30-40%. Treatment 77

What percentage of patients present with locally advanced or metastatic disease?

50-60%. Treatment 78

What is the typical treatment for stage I or II pancreatic cancer?

Primary surgical resection followed by adjuvant chemotherapy. Treatment 79

What is the typical treatment for stage II or III pancreatic cancer with borderline resectability?

Neoadjuvant therapy followed by surgical resection. Treatment 80

What is the typical treatment for stage III pancreatic cancer with locally advanced unresectable disease?

Combination chemotherapy. Treatment 81

What is the typical treatment for stage IV pancreatic cancer?

Combination chemotherapy. Treatment 82

What is the only potentially curative treatment for pancreatic cancer?

Surgical resection. Treatment 83

What is the Whipple procedure?

Resection of pancreatic head, distal stomach, duodenum, gallbladder, and common bile duct. Treatment 84

What is the Traverso-Longmire procedure?

Pylorus-preserving pancreaticoduodenectomy. Treatment 85

What is the typical resection for pancreatic body and tail cancer?

Resection of the left side of the pancreas with splenectomy. Treatment 86

What is neoadjuvant therapy used for in pancreatic cancer?

To improve resectability. Treatment 87

What is adjuvant therapy used for in pancreatic cancer?

To increase long-term survival. Treatment 88

What is the typical treatment intent for locally advanced and metastatic disease?

Palliative. Treatment 89

What is the treatment for locally advanced disease if preoperative treatment leads to improved resectability?

Surgical resection. Treatment 90

What treatments are available for locally advanced pancreatic cancer?

Combination of chemotherapy, chemoradiotherapy, and/or stereotactic body radiation therapy. Treatment 91

How is metastatic disease approached?

Depends on performance status, symptom burden, and comorbidity profile. Treatment 92

What are some chemotherapy regimens used in metastatic pancreatic cancer?

e.g., FOLFIRINOX, nab-paclitaxel PLUS gemcitabine. Treatment 93

What supportive care measures are important in pancreatic cancer?

Pain management, nutrition, and treatment of exocrine pancreatic insufficiency. Treatment 94

How is severe pain managed in pancreatic cancer?

Following the WHO analgesic ladder and considering early consultation with a pain specialist, as well as radiotherapy and advanced interventions. Treatment 95

What are advanced interventions for pain in pancreatic cancer?

Celiac ganglion block and thoracoscopic splanchnicectomy. Treatment 96

What is a celiac ganglion block?

EUS-guided transgastric puncture of the celiac ganglion with instillation of 98% ethanol to destroy the nerve tissue. Treatment 97

What is thoracoscopic splanchnicectomy?

Unilateral or bilateral sectioning of the splanchnic nerve. Treatment 98

What are some supportive care measures for cancer anorexia-cachexia syndrome?

Obtain nutrition counseling, consider nutritional supplements, appetite stimulants, and treat exocrine pancreatic insufficiency. Treatment 99

Where do pancreatic cancer metastases commonly occur?

Liver, nearby lymph nodes, surrounding visceral organs (duodenum, stomach, colon), and lungs. Complications 100