Term
| pancreatic cancer risk factors |
|
Definition
older age (> 50 yo)
smoking
increases relative risk by ~2.5
chronic pancreatitis
diabetes
alcoholism
high fat diet
occupational exposure to petroleum, DDT
obesity and inactivity |
|
|
Term
| presenting symptoms of pancreatic cancer |
|
Definition
depend on site of tumor and degree of involvement
symptoms:
no symptoms - tail of pancreas
pain - most common symptoms; NEUROPATHIC PAIN b/c the pancreas is near a neuropathic plexus; treat with gabapentin, pregabalin, duloxetine
painless jaundice - biliary obstruction
glucose intolerance
weight loss - nearly universal b/c pancreatic enzymes are not being secreted and food is not processed
GI bleeding - tumor in the head or ampulla
steatorrhea
pruritus of palms and soles (metastatic disease); build of of bilirubin causes itching
signs:
diabetes
jaundice
cachexia (decreased albumin to < 3.5 mg/dL)
hepatomegaly
epigastric mass |
|
|
Term
| pancreatic cancer diagnostic studies |
|
Definition
Labs: CBC, LFTs
imaging: chest and abdomen
liver or bone scan if labs indicate involvement
biopsy: suspected mets and primary tumor |
|
|
Term
| pancreatic cancer prognostic factors |
|
Definition
local: can be operated on
regional: hasn't spread to distant sites but is not operable
distant spread: not operable |
|
|
Term
| stage at presentation of pancreatic cancer |
|
Definition
| half of patients present in stage IV |
|
|
Term
| treatment of resectable tumors (local) |
|
Definition
standard:
radical pancreatic resection (Whipple procedure): removal of part of the pancreas, duodenum, part of the stomach, gall bladder, part of the bile duct
adjuvant chemotherapy:
gemcitabine single agent
OR
5FU/leucovorin |
|
|
Term
| treatment of unresectable locally advanted tumors |
|
Definition
good performance status:
FOLFIRINOX (5FU, leucovorin, irinotecan, oxaliplatin)
gemcitabine combinations - erlotinib, capecitabine, docetaxel
poor performance status: gemcitabine |
|
|
Term
| treatment of unresectable metastatic tumors |
|
Definition
same as non-metastatic
good performance status:
FOLFIRINOX (5FU, leucovorin, irinotecan, oxaliplatin)
gemcitabine combinations - erlotinib, capecitabine, docetaxel
poor performance status: gemcitabine |
|
|
Term
| role of radiation in pancreatic cancer |
|
Definition
| historically 5FU + radiation was used...and is still used in addition to chemotherapy but no standard recommendations |
|
|
Term
| pancreatic cancer supportive care |
|
Definition
pain management: pregabalin, duloxetine, gabapentin
pancreatic enzymes
diet:
small meals and snacks
low in fat, high in carbs (insulin is usually the last thing to go (lose amylase and lipase first)
supplements |
|
|
Term
| goals of pancreatic cancer therapy |
|
Definition
local disease - resectable:
cure; prolong life
regional disease - not resectable:
prolong life; palliation of symptoms
distant mets (stage IV):
palliation of symptoms |
|
|
Term
|
Definition
IMPROVE CHANCE OF CURE FOR PATIENTS WITH RESECTABLE DISEASE
PROLONG LIFE
IMPROVE QUALITY OF LIFE
minimzie drug toxicity
manage symptoms: pain management; pancreatic insufficiency |
|
|
Term
| chemotherapy regimen: FOLFIRINOX |
|
Definition
5FU, leucovorin, irinotecan, oxaliplatin
ADRs:
QUICK:
hypersensitivity
SHORT TERM:
N/V
myelosuppression
mucositis
alopecia
hand-foot syndrome
neuropathies
diarrhea
LONG TERM:
hepatotoxicity |
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