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Pancreas Cancer

Pancreas Cancer. Nimisha K. Parekh, MD, MPH Director, Inflammatory Bowel Disease Program H. H. Chao Comprehensive Digestive Disease Center Assistant Professor of Clinical Medicine University of California Irvine. Pancreas. The Facts.

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Pancreas Cancer

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  1. Pancreas Cancer Nimisha K. Parekh, MD, MPH Director, Inflammatory Bowel Disease Program H. H. Chao Comprehensive Digestive Disease Center Assistant Professor of Clinical Medicine University of California Irvine

  2. Pancreas

  3. The Facts • 38,000 Americans will be diagnosed with pancreatic cancer this year • 34,000 will die from the disease this year • pancreatic cancer is the 4th leading cause of cancer-related death in the US • 5-year survival rate is 5 percent • Seventy-five percent of pancreatic cancer patients die within the first 12 months of the diagnosis

  4. The Facts • Low survival rates are due to the fact that fewer than 10% of patients' tumors are confined to the pancreas at the time of diagnosis • In most cases, the tumor has progressed to the point where surgery is impossible.

  5. Types of Pancreatic Tumors • Ductal Adenocarcinomas (85%) • Two thirds in head of pancreas • Undifferentiated carcinomas • Acinar cell carcinomas (1-2%) • Sarcomatoid carcinoma/Carcinosarcoma (<1%) • Serous cystic neoplasms • Mucinous cystic neoplasms • Intraductal papillary mucinous neoplasms • NeuroEndocrine

  6. Who should be screened? • Not everyone should be screened for pancreatic cancer. • Screening makes sense for people who are at risk for the disease typically because of hereditary factors or genetic syndromes that increase the likelihood of developing pancreatic cancer.

  7. Factors that Increase an Individual's Risk for Pancreatic Cancer • Cigarette Smoking • Alcohol • BMI/Obesity • Physical Activity • Diabetes?? • Gender (M>F) • Family History • Genetic Syndromes associated with pancreas cancer

  8. Family History Risk Factors • Two or more first-degree relatives (parents, sibling, child) with pancreatic cancer • One first-degree relative diagnosed with pancreatic cancer at an early age (under the age of 50) • Two or more second-degree relatives (grandparent, aunt/uncle, niece/nephew, half-sibling) with pancreatic cancer, one of whom developed it at an early age • History of a cancer syndrome associated with pancreatic cancer

  9. Genetic Syndromes Associated with Pancreatic Cancer

  10. Diagnosis • CT Scans • MRI • ERCP • Endoscopic Ultrasound • Laparascopy

  11. Helical CT and MRI/MRCP

  12. MRCP: Pancreatic Cancer Barish, NEJM, July 1999

  13. EUS-Guided FNA • Nodal staging • Mediastinal: esophageal, lung • Abdominal/celiac: gastric, pancreas • Pelvis: rectal • Distant Metastasis • Liver • Pleural/abdominal fluid • Adrenal

  14. Pancreatic Body Mass UCSF Patient – MRCP – x 2; ERCP non-diagnostic; CT negative

  15. ERCP vs. EUS for Pancreatic Masses • EUS • Most Sensitive (well over 90%) • NCI recommends this over CT guided biopsy • ERCP • Diagnostic Yield between 40-70% Image courtesy of Van Dam and Brugge, NEJM, 2003

  16. Pancreatic Cancer - Detection EUS detected all tumors less than 2cm Schoefer et al, Abstract 1530, DDW 2000

  17. Staging of Pancreas Tumors • Stage I. Cancer is confined to the pancreas. • Stage II. Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes. • Stage III. Cancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph nodes. • Stage IV. Cancer has spread to distant sites beyond the pancreas, such as the liver, lungs and the lining that surrounds your abdominal organs

  18. Treatments • Surgery • Radiation • Chemotherapy • Combination of above

  19. Anatomy of a Whipple

  20. Final Points • Familial Pancreatic Cancer /National Familial Pancreas Tumor Registry • Hirshberg Foundation for Pancreatic Cancer Research • NIH • UCLA, UCI, City of Hope have pancreas programs • Healthy lifestyle

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