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{{Pancreatic cancer}}
{{Pancreatic cancer}}
{{CMG}}; {{AE}} {{Cherry}}
{{CMG}}; {{AE}} {{Cherry}}
{| class="wikitable"
! rowspan="2" |Disease
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! colspan="2" |History and Symptoms
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! rowspan="2" |Physical examination
! rowspan="2" |Laboratory findings
! rowspan="2" |Imaging findings
! rowspan="2" |Comments
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!Abdominal pain
!Steatorrhea
!Weight loss
!Fever
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|[[Chronic pancreatitis]]
|✔
|✔
|✔
|<nowiki>-</nowiki>
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|[[Diabetes mellitus|DM type II]], [[amylase]] and [[lipase]] levels may be slightly elevated
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|Pancreatic cancer
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|Ampullary carcinoma
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|Autoimmune pancreatitis
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|Lymphoma
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|Pancreatic endocrine tumors
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|Acute pancreatitis
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|Cholangitis
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|Biliary obstruction
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|Pseudocyst
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|Pancreatic duct stricture/stone
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|Cholecystitis
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|Chronic gastritis
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|Community-Acquired Pneumonia (CAP)
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|Intestinal perforation
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|Crohn disease
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|Myocardial infarction
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|Mesenteric artery ischemia
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|Peptic ulcer disease
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|[[Retroperitoneal hematoma]]
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|[[Anemia]]
|[[MRI]] is the best radiologic tool to differentiate between retroperitoneal masses.
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|[[Retroperitoneal abscess]]
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|[[Leukocytosis]], positive inflammatory markers
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|Retroperitoneal tumors (.e.g. [[liposarcoma]])
|✔
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|✔
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|positive [[tumor marker]]
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|}


==Treatment Options by Stage==
==Treatment Options by Stage==

Revision as of 22:02, 14 November 2017

Pancreatic cancer Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pancreatic Cancer from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Staging

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Sandbox:Cherry On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Sandbox:Cherry

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Sandbox:Cherry

CDC on Sandbox:Cherry

Sandbox:Cherry in the news

Blogs on Sandbox:Cherry

Directions to Hospitals Treating Pancreatic cancer

Risk calculators and risk factors for Sandbox:Cherry

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]


Disease History and Symptoms Physical examination Laboratory findings Imaging findings Comments
Abdominal pain Steatorrhea Weight loss Fever
Chronic pancreatitis ✔ ✔ ✔ - DM type II, amylase and lipase levels may be slightly elevated
Pancreatic cancer
Ampullary carcinoma
Autoimmune pancreatitis
Lymphoma
Pancreatic endocrine tumors
Acute pancreatitis
Cholangitis
Biliary obstruction
Pseudocyst
Pancreatic duct stricture/stone
Cholecystitis
Chronic gastritis
Community-Acquired Pneumonia (CAP)
Intestinal perforation
Crohn disease
Myocardial infarction
Mesenteric artery ischemia
Peptic ulcer disease
Retroperitoneal hematoma ✔ Anemia MRI is the best radiologic tool to differentiate between retroperitoneal masses.
Retroperitoneal abscess ✔ ✔ Leukocytosis, positive inflammatory markers
Retroperitoneal tumors (.e.g. liposarcoma) ✔ ✔ ✔ positive tumor marker



Treatment Options by Stage

Stages I and II Pancreatic Cancer

Treatment of stage I and stage II pancreatic cancer may include the following:

  • Surgery alone.
  • Surgery with chemotherapy and radiation therapy.

Stage III Pancreatic Cancer

Treatment of stage III pancreatic cancer may include the following:

  • Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.
  • Chemotherapy with gemcitabine.

Stage IV Pancreatic Cancer

Treatment of stage IV pancreatic cancer may include the following:

  • Chemotherapy with gemcitabine with or without erlotinib.
  • Palliative treatments for pain, such as nerve blocks, and other supportive care.
  • Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.

Treatment Options for Recurrent Pancreatic Cancer

Treatment of recurrent pancreatic cancer may include the following:

  • Chemotherapy.
  • Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.
  • Palliative radiation therapy.
  • Other palliative medical care to reduce symptoms, such as nerve blocks to relieve pain.

prevention

Primary Cessation of cigarette smoking: The risk of pancreatic cancer falls with cessation of cigarette smoking, which is one of the most important modifiable risk factors.[1][2][3][4][5][6][6][7][8] Smoking accounts for the incidence of pancreatic cancer in one-fourth of all cases.[1][9] Nicotine in cigarettes stimulates tumorigenesis, increasing metastasis and resistance to treatment, hence impacting survival in patients.[10] The risk of developing pancreatic cancer becomes almost equivalent to that of a nonsmoker after five years of cessation.[2][11][4][8]


Regular exercise: Obesity is considered as a potential risk factor for pancreatic cancer.[12] Regular exercise decreases the risk of pancreatic cancer as compared to people living a sedentary lifestyle.[4][13]

The American Cancer Society (ACS) has issued guidelines for diet and physical activity at individual and community levels. Diet: A healthy balanced diet doesn't exceed 2000 calories daily and includes the following:[5][7][14] plenty of vegetables and fruits- blueberries, spinach, broccoli, tomatoes lean meat from fowl, fish and plant sources like nuts or whole grains monounsaturated fats help control insulin levels in type 2 diabetics[8] Tuna, mackerel, salmon, and sardine are major sources of long-chain omega-3 fatty acids due to anticancer properties

Poor diet: A poor diet includes the presence of the following:[12][2][14] Food preservatives and additives Smoked meat Heavy alcohol use High cholesterol Red meat Low consumption of fruits and vegetables Saturated fatty acids Processed foods high-fat, high-protein diet Chemicals known as heterocyclic amines, nitrates, and heme iron, found in foods, are capable of damaging cells and DNA, influencing cancerogenic processes

Aging: Aging is associated with the development of pancreatic cancer.[11][11][4]


Secondary Diet: Exocrine pancreatic insufficiency due to pancreatic duct obstruction by the tumor may lead to malabsorption. Malabsorption in patients presents with anorexia, weight loss, and diarrhea. Treatment: based on American Cancer Society(ACS) guidelines[15] Pancreatic enzyme replacement therapy avoidance of high-protein/high-fat diets Individualized dietary prescriptions from a registered dietitian Supplementation with omega-3 fatty acids

Palliative Therapy

Pain:

Jaundice:

  • Types of stents:
    • Metal- costly, longer lifespan
    • Plastic- cheaper, need replacement every three months

Duodenal obstruction

  1. ↑ 1.0 1.1 Bochatay L, Girardin M, Bichard P, Frossard JL (2014). "[Pancreatic cancer in 2014: screening and epidemiology]". Rev Med Suisse (in French). 10 (440): 1582–5. PMID 25276995.
  2. ↑ 2.0 2.1 2.2 Lowenfels AB, Maisonneuve P (2006). "Epidemiology and risk factors for pancreatic cancer". Best Pract Res Clin Gastroenterol. 20 (2): 197–209. doi:10.1016/j.bpg.2005.10.001. PMID 16549324.
  3. ↑ Bosetti C, Bertuccio P, Malvezzi M, Levi F, Chatenoud L, Negri E, La Vecchia C (2013). "Cancer mortality in Europe, 2005-2009, and an overview of trends since 1980". Ann. Oncol. 24 (10): 2657–71. doi:10.1093/annonc/mdt301. PMID 23921790.
  4. ↑ 4.0 4.1 4.2 4.3 Bosetti C, Bertuccio P, Negri E, La Vecchia C, Zeegers MP, Boffetta P (2012). "Pancreatic cancer: overview of descriptive epidemiology". Mol. Carcinog. 51 (1): 3–13. doi:10.1002/mc.20785. PMID 22162227.
  5. ↑ 5.0 5.1 Hart AR (1999). "Pancreatic cancer: any prospects for prevention?". Postgrad Med J. 75 (887): 521–6. PMC 1741344. PMID 10616684.
  6. ↑ 6.0 6.1 Vimalachandran D, Ghaneh P, Costello E, Neoptolemos JP (2004). "Genetics and prevention of pancreatic cancer". Cancer Control. 11 (1): 6–14. PMID 14749618.
  7. ↑ 7.0 7.1 Ghadirian P, Lynch HT, Krewski D (2003). "Epidemiology of pancreatic cancer: an overview". Cancer Detect. Prev. 27 (2): 87–93. PMID 12670518.
  8. ↑ 8.0 8.1 8.2 Landi S (2009). "Genetic predisposition and environmental risk factors to pancreatic cancer: A review of the literature". Mutat. Res. 681 (2–3): 299–307. doi:10.1016/j.mrrev.2008.12.001. PMID 19150414.
  9. ↑ Qiu D, Kurosawa M, Lin Y, Inaba Y, Matsuba T, Kikuchi S, Yagyu K, Motohashi Y, Tamakoshi A (2005). "Overview of the epidemiology of pancreatic cancer focusing on the JACC Study". J Epidemiol. 15 Suppl 2: S157–67. PMID 16127228.
  10. ↑ Toki MI, Syrigos KN, Saif MW (2014). "Risk determination for pancreatic cancer". JOP. 15 (4): 289–91. PMID 25076322.
  11. ↑ 11.0 11.1 11.2 Li D, Xie K, Wolff R, Abbruzzese JL (2004). "Pancreatic cancer". Lancet. 363 (9414): 1049–57. doi:10.1016/S0140-6736(04)15841-8. PMID 15051286.
  12. ↑ 12.0 12.1 Bracci PM (2012). "Obesity and pancreatic cancer: overview of epidemiologic evidence and biologic mechanisms". Mol. Carcinog. 51 (1): 53–63. doi:10.1002/mc.20778. PMC 3348117. PMID 22162231.
  13. ↑ Kollarova H, Azeem K, Tomaskova H, Horakova D, Prochazka V, Martinek A, Shonova O, Sevcikova J, Sevcikova V, Janout V (2014). "Is physical activity a protective factor against pancreatic cancer?". Bratisl Lek Listy. 115 (8): 474–8. PMID 25246281.
  14. ↑ 14.0 14.1 Kuroczycki-Saniutycz S, Grzeszczuk A, Zwierz ZW, Kołodziejczyk P, Szczesiul J, Zalewska-Szajda B, Ościłowicz K, Waszkiewicz N, Zwierz K, Szajda SD (2017). "Prevention of pancreatic cancer". Contemp Oncol (Pozn). 21 (1): 30–34. doi:10.5114/wo.2016.63043. PMC 5385470. PMID 28435395.
  15. ↑ Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, Gapstur S, Patel AV, Andrews K, Gansler T (2012). "American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity". CA Cancer J Clin. 62 (1): 30–67. doi:10.3322/caac.20140. PMID 22237782.
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