The document provides tips and instructions for using a PowerPoint presentation on pancreatic cancer. It discusses how to actively engage students by starting with blank slides to elicit their existing knowledge on topics before presenting additional information on subsequent slides. The presentation covers learning objectives, relevant anatomy, risk factors, pathology, clinical features including symptoms and investigations, staging, differential diagnosis, and management approaches for pancreatic cancer such as surgery, chemotherapy and radiation therapy.

1. Tips on using my ppt.
1. You can freely download, edit, modify and put your
name etc.
2. Don’t be concerned about number of slides. Half the
slides are blanks except for the title.
3. First show the blank slides (eg. Aetiology ) > Ask
students what they already know about ethology of
today's topic. > Then show next slide which enumerates
aetiologies.
4. At the end rerun the show – show blank> ask questions >
show next slide.
5. This will be an ACTIVE LEARNING SESSION x
three revisions.
6. Good for self study also.
7. See notes for bibliography.

2. Learning Objectives

3. Learning Objectives
1. Introduction & History
2. Relevant Anatomy, Physiology
3. Aetiology
4. Pathophysiology
5. Pathology
6. Classification
7. Clinical Features
8. Investigations
9. Management
10. Prevention
11. Guidelines
12. Take home messages

4. Introduction & History.
•

5. Introduction & History.
• Pancreatic cancer is the tenth most common
cancer in men and the eighth most common
in women
• Fourth leading cause of cancer deaths,
• Responsible for about 7% of all cancer-
related deaths.

6. Relevant Anatomy

7. Relevant Anatomy
• Approximately 75% of all pancreatic
carcinomas occur within the head or neck of
the pancreas
• 15-20% occur in the body of the pancreas.
• 5-10% occur in the tail.

8. Aetiology

9. Aetiology
• Idiopathic
• Congenital/ Genetic
• Nutritional Deficiency/excess
• Traumatic
• Infections /Infestation
• Autoimmune
• Neoplastic (Benign/Malignant)
• Degenerative
• Iatrogenic
• Psychosomatic
• Poisoing/ Toxins/ Dtug induced

10. Aetiology: Risk Factors
• Tobacco smoking is the most common recognized
risk factors
• obesity,
• high alcohol consumption,
• history of pancreatitis
• Diabetes
• family history of pancreatic cancer, and possibly
selected dietary factors. [11] Only 5-10% are
hereditary in nature.

11. Aetiology
Dietary factors
• The incidence of pancreatic cancer is lower in
persons with a diet rich in fresh fruits and
vegetables.
• Consumption of red meat, especially of the
processed kinds, is associated with a higher risk of
pancreatic cancer.
• Despite early reports to the contrary, coffee
consumption is not associated with an increased
risk of pancreatic cancer.

12. Aetiology
Genetic factors
• Approximately 5-10% of patients with pancreatic
carcinoma have some genetic predisposition to
developing the disease
• Mutations in the KRAS2 gene;
• Mutations, deletions, or hypermethylation in
the CDKN2 gene;
• Mutations in p53;
• Homozygous deletions or mutations in smad4.
• Families with BRCA-2 mutations, which are
associated with a high risk of breast cancer, also
have an excess of pancreatic cancer.

13. Aetiology
Genetic factors
The inherited disorders that increase the risk of
pancreatic cancer include
• hereditary pancreatitis
• multiple endocrine neoplasia(MEN,
• hereditary nonpolyposis rectal cancer(HNPCC)familial
adenomatous polyposis(FAP)
• Gardner syndrom
• familial atypical multiple mole melanoma (FAMMM)
syndrome,
• von Hippel-Lindau syndrom(VHL)
• germline mutations in the BRCA1 and BRCA2 genes.

14. Pathology

15. Pathology
• Pancreatic cancers can arise from the exocrine and
endocrine portions of the pancreas
• 93% of them develop from the exocrine portion,
including the ductal epithelium, acinar cells,
connective tissue, and lymphatic tissue.

16. Pathology
• 80% are adenocarcinomas of the ductal
epithelium.
• Only 2% of tumors of the exocrine pancreas are
benign
• Giant cell carcinoma, adenosquamous carcinoma,
microglandular adenocarcinoma, mucinous
carcinoma, cystadenocarcinoma, papillary cystic
carcinoma, acinar cystadenocarcinoma, and acinar
cell cystadenocarcinoma.
• Very rarely, pancreatic lymphoma.

17. Pathophysiology
• Typically, pancreatic cancer first metastasizes to
regional lymph nodes, then to the liver and, less
commonly, to the lungs.
• invade surrounding visceral organs such as the
duodenum, stomach, and colon,
• it can metastasize to any surface in the abdominal
cavity via peritoneal spread.
• Ascites
• Pancreatic cancer may spread to the skin as
painful nodular metastases. Metastasis to bone is
uncommon.

18. Pathophysiology
• Metastasis to bone is uncommon.
• Pancreatic cancer rarely spreads to the brain, but it
can produce meningeal carcinomatosis.

19. Clinical Features

20. Clinical Features
• Demography
• Symptoms
• History
• Signs
• Prognosis
• Complications

21. Clinical Features
Triad of Ca. Head of Pancreas
1. Weight loss
2. Abd. Pain
3. Jaundice

22. Demography

23. Demography
• 3% of all cancers in the United States,
• The average lifetime risk of developing
pancreatic cancer is about 1 in 64.
• Incidence 7.7 per 100,000 population in
Europe to 2.2 per 100,000 population in
Africa.
• .81 per 100,000 in males in India
• Rising

24. Demography
• Race: more in black men.
• Age: unusual in persons younger than 45
years. After age 50 years, the frequency of
pancreatic cancer increases linearly.
• The median age at diagnosis is 69 years in
whites and 65 years in blacks.
• Sex: Slightly more in males.

25. Symptoms

26. Symptoms
• Nonspecific and subtle..
• Gradual onset of nonspecific symptoms
such as anorexia, malaise, nausea, fatigue,
and midepigastric or back pain.
• Significant weight loss..
• Midepigastric pain: common symptom of
pancreatic cancer, sometimes with radiation
of the pain to the midback or lower-back
region
• Unrelenting pain: nighttime pain

27. Symptoms
• Onset of diabetes mellitus within the
previous year.
• Painless obstructive jaundice:
• Pruritus
• Depression
• Migratory thrombophlebitis (ie, Trousseau
sign)
• Palpable gallbladder (ie, Courvoisier sign)

28. Advanced intra-abdominal disease:
• Ascites, a palpable abdominal mass,
hepatomegaly from liver metastases, or
splenomegaly from portal vein obstruction
• Paraumbilical subcutaneous metastases (or
Sister Mary Joseph nodule or nodules)
• Possible presence of palpable metastatic
mass in the rectal pouch (Blumer shelf)
• Troisier sign Nodes palpable behind the
medial end of the left clavicle (Virchow
node)

29. Prognosis

30. Prognosis
• The collective median survival time for all
patients is 4-6 months.
• The relative 1-year survival rate for patients
with pancreatic cancer is only 28%,
• Overall 5-year survival rate is 9%,

31. Investigations

32. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histology
• Diagnostic Laparotomy.

33. Investigations
• mild normochromic anemia.
• Thrombocytosis
• obstructive jaundice elevations in bilirubin
(conjugated and total), alkaline
phosphatase, gamma-glutamyl
transpeptidase, and to a lesser extent,
aspartate aminotransferase and alanine
aminotransferase.
• Serum amylase and/or lipase levels may
elevated

34. Investigations
• Laboratory Studies
– Tumor markers
• CA 19-9 antigen75-85% have elevated CA 19-9
levels
• CEA:; 40-45% have elevated CEA levels

35. Diagnostic Studies
Imaging Studies
• X-Ray
• USG
• CT
• Angiography
• MRI MRCP
• Endoscopy EUS
• Nuclear scan PET

36. Imaging Studies

37. Imaging Studies
• CT scanning
• Ultrasonography
• Endoscopic ultrasonography
• Magnetic resonance imaging
• Endoscopic retrograde
cholangiopancreatography
• Positron emission tomography scanning
• Germline Testing and Molecular Analysis

38. Imaging Studies
•

39. Differential Diagnosis

40. Differential Diagnosis
• Many patients have sought care for
symptoms for weeks or months before
receiving a definitive diagnosis of
pancreatic cancer
• consider pancreatic cancer in patients with
diabetes who have unusual symptoms such
as continuous weight loss and abdominal
problems.

41. Differential Diagnosis
• Abdominal aortic
aneurysm
• Ampullary carcinoma
• Intestinal ischemia
• Gastric lymphoma
• Pancreatic lymphoma
• Hepatocellular carcinoma
(hepatoma)
• Bile duct strictures
• . Neoplasms of the
endocrine pancreas
• Acute Pancreatitis
• Cholangitis
• Cholecystiti
• Choledochal Cysts
• Chronic Pancreatiti
• Gallstones
• Gastric Cancer
• Peptic Ulcer DiseaseBile
duct tumors

42. Staging

43. Staging
• Pancreatic masses are characterized as
resectable, unresectable, or borderline
resectable.
• The last designation, borderline resectable,
is usually based on the experience and
technical skill of the surgeon involved in
treatment, as well as on the overall health of
the patient and on his or her wishes.

44. TNM staging system.
Tumor (T)
• TX - Primary tumor cannot be assessed
• T0 - No evidence of primary tumor
• Tis - Carcinoma in situ
• T1 - Tumor limited to the pancreas, 2 cm or smaller in
greatest dimension
• T2 - Tumor limited to the pancreas, larger than 2 cm in
greatest dimension
• T3 - Tumor extension beyond the pancreas (eg, duodenum,
bile duct, portal or superior mesenteric vein) but not
involving the celiac axis or superior mesenteric artery
• T4 - Tumor involves the celiac axis or superior mesenteric
arteries

45. TNM staging system.
Tumor (T)
•

46. TNM staging system.
Regional lymph nodes (N)
• NX - Regional lymph nodes cannot be
assessed
• N0 - No regional lymph node metastasis
• N1 - Regional lymph node metastasis
Distant metastasis (M)
• MX - Distant metastasis cannot be assessed
• M0 - No distant metastasis
• M1 - Distant metastasis

47. TNM staging system.
Stage grouping for pancreatic cancer :
• Stage 0 - Tis, N0, M0
• Stage IA - T1, N0, M0
• Stage IB - T2, N0, M0
• Stage IIA - T3, N0, M0
• Stage IIB - T1-3, N1, M0
• Stage III - T4, Any N, M0
• Stage IV - Any T, Any N, M1

48. Preoperative staging laparoscopy
• To avoid subjecting patients with liver or
peritoneal metastases to unnecessary
surgery.

49. Management

50. Management
• Surgery is the primary mode of treatment
for pancreatic cancer.
• However, an important role exists for
chemotherapy and/or radiation therapy.

51. Chemotherapy
• Modified FOLFIRINOX (5-fluorouracil [5-
FU], Oxaliplatin, Irinotecan.
• gemcitabine and capecitabine
• Gemcitabine monotherapy

52. Operative Therapy
• Pancreaticoduodenectomy (Whipple
procedure), with/without sparing of the
pylorus
• Total pancreatectomy
• Distal pancreatectomy

53. Minimally invasive Therapy
• Some Pioneer have done pancreatic
resections including whipple’s procedure
laparoscopically.

54. Palliative Therapy
• Pain: Pain relief is crucial for patients not
undergoing resection for pancreatic cancer;
narcotic analgesics should be used early and in
adequate dosages.
• Jaundice: Obstructive jaundice warrants palliation
if the patient has pruritus or right upper quadrant
pain or has developed cholangitis
• Duodenal obstruction secondary to pancreatic
carcinoma: Can be palliated operatively with a
gastrojejunostomy or an endoscopic procedure

55. Palliative Therapy Diet
• anorexic. Pharmacologic stimulation of appetite is
usually unsuccessful, but it may be tried.
• Patients with malabsorption diarrhea and weight
loss may benefit from pancreatic enzyme
supplementation.
• Their diarrhea may also be improved by avoidance
of high-fat or high-protein diets.

56. Futuristic

57. Futuristic
Unresectable locally advanced
local ablation
• Radiofrequency ablation (RFA)
• Irreversible electroporation
• Stereotactic body radiation therapy (SBRT)
• High-intensity focused ultrasound (HIFU)
• Iodine-125
• Iodine-125–cryosurgery
• Photodynamic therapy
• Microwave ablation

58. Futuristic
• Precision medicine
• The PRIMUS-004 trial will use cell lines
and organoids generated from patients with
pancreatic cancer to develop new molecular
markers to predict response to agents that
target DNA damage.

59. Prevention
• Tobacco smoking is the most common
recognized risk factors
• obesity,
• high alcohol consumption,
• history of pancreatitis
• Diabetes
• family history of pancreatic cancer, and
possibly selected dietary factors. [11] Only 5-
10% are hereditary in nature.

60. Guidelines
• American Society of Clinical Oncology
(ASCO)
• National Comprehensive Cancer Network
(NCCN).

61. Get this ppt in mobile
1. Download Microsoft
PowerPoint from play
store.
2. Open Google assistant
3. Open Google lens.
4. Scan qr code from
next slide.

63. Get this ppt in mobile
1. Download Microsoft
PowerPoint from play
store.
2. Open Google assistant
3. Open Google lens.
4. Scan qr code from
next slide.

64. Get this ppt in mobile

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