August
2007
Pancreatic Cancer
Pancreatic cancer is the #4 killing cancer in USA. About 33,000 cases occur a year and about 32,000 deaths a year from pancreatic cancer. It is deadly because it isn’t diagnosed until too late. Only 15% of those diagnosed with pancreatic cancer are considered for surgery, but even then their 5 year survival rate is only 25% (if no spread to lymph nodes) and 10% for those with spread to lymph nodes.
Risk factors: Usually occurs after the age of 45. Greater in men and in African Americans. Smoking, diabetes mellitus, chronic pancreatitis, and genetics. 10% persons with pancreatic cancer have family history of it.
Clinical: Weight Loss, Abdominal Pain (from navel region radiating straight to the back), and jaundice. The belly pain is often worse with eating and is a dull ache. Fatty stools (floaters and light colored stools) and diarrhea due to pancreatic insufficiency, anorexia, and early satiety (feeling filled up after on a few bites). Bloating and belching can be early symptoms. Virchow’s node is a left supraclavicular lymph node. Symptoms probably start 3 years before diagnosis is made.
Diagnosis: abdominal ultrasound is 80% sensitive in picking up pancreatic cancer. CT, MRI are 90% sensity. ERCP (endoscopy all the way into the duodenum) is 90% sensitive. A fine needle aspirate is 90% sensitive (guided by ultrasound or CT). Though not proven doing the needle aspirate can spread the tumor by “leaking” cancer cells out, it isn’t usually done in a patient who is going to have surgical resection.
For staging the spread of the cancer, Helical CT and IV contrast (for CT angiography) can see if the cancer has spread into the major arteries and veins. Hopefully it hasn’t. But it isn’t sensitive enough to pick up metastasis to the liver if the cancers there are small. MRCP is better at detecting spread of cancer into the liver.
Endoscopic ultrasound is 90% sensitive in detecting pancreatic cancer and can be useful in staging.
CA 19-9 is a blood test to check on the pancreatic tumor marker. It is about 80% sensitive so isn’t good as a screen for early pancreatic cancer. The bigger the tumor, the higher the CA 19-9. So high level such as more than 1000 usually indicates surgery isn’t going to be helpful.
Treatment: Surgery with adjuvant chemotheraphy might be helping people survive longer – in those who were candidates for surgery. For those with inoperatable cancer, palliative treatment (meaning minimize the pain and problems) is suggested.
Prevention: for those at higher risk for pancreatic cancer, it has not been shown yet if checking tumor marker CA 19-9 is useful and having CT scan or ultrasound will work. Also your insurance, if you have it, probably won’t cover it.
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drjohnhong 
Uncategorized, cancer 
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