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 Pancreatic cancer in 2004, died in 2011
Diagnosed with stage IV pancreatic cancer
Jan 2008
Died Sept 14, 2009
• 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
Most common


 Lung
 Adrenal
 Bone
 Rarely CNS
Resectable disease Surgery only curative modality but
only 5-20% are resectable

Stages I-II
(20%)

Surgery
Adjuvant chemotherapy
Adjuvant radiation
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