pancreatic cancer

2. OVERVIEW
 In Mexico and the US is the 4th cause of death from cancer.
 Mortality is very high (incidence rate = mortality rate ).
 Poor prognosis. The survival 1 to 5 years ( all stages combined ) are 24 % and
5% respectively

3. EPIDEMIOLOGY
G L O B O C A N 2 0 1 2 ( I A R C )
Rate indecency and global mortality
15O 7O
 The 5th most common GI
malignancy
 5th leading cause of death for
GI malignancies

4. EPIDEMIOLOGY
INEGI reported (2010)
 74.685 cancer deaths (13 % deaths in Mexico ) of which 3,393
(4.8 %) they were by CP , ranking 8th place in our country.
 With a fatality rate of 0.96 , almost 100 % of patients die from this
disease annually

5. RISK FACTORS
ACQUIRED
risk factor
Relative risk comments
tobacco 2-5 Greater exposure -- greater risk
Diabetes mellitus 2
It is very common in patients with CP . The mechanism is not
well understood . The DM is involved as an early
manifestation of CP and also as a risk factor . It is believed
that insulin resistance and hyperinsulinemia secondary are
involved in pancreatic carcinogenesis.
High IMC 2
Chronic pancreatitis 13-18
The risk is 2 % per decade , regardless of the type of
pancreatitis

6. PATOLOGY
 Over 95% of pancreatic malignancies arising from exocrine gland
elements ( ductal and acinar cells )
 Endocrine neoplasia correspond only 1-2% of cases of pancreatic
tumors .
 Non- epithelial neoplasms are extremely rare.
ADENOCARCINOMA

7. PATOLOGY
WHO proposed a classification for pancreatic exocrine tumors that are
widely used today

8. PATOLOGY

9. PATOLOGY
Ductal adenocarcinomas corresponds to 85 to 95 % of cases of
pancreatic tumors
Autopsies show that :
• 60% - 79% of these tumors are located in the head of the gland
• 5-10% (5%) in the body
• 10-15% in the tail

10. PATOLOGY
Jaundice and
chronic pancreatitis
Head tumors tend
to obstruct the
pancreatic duct
common (more
distal) Se observan cambios
patológicos como
dilatación ductal y atrofia
fibrosa del parénquima
pancreático
They may involve
the ampulla and
duodenum
Compared to the
body and tail that are
5 to 7 cm
The average size of
the tumors of the
head are 2.5-3.5 cm

11. PATOLOGY
 The Extrapancreatic extension to the
retroperitoneal tissue is almost always
present at diagnosis .
 There may be invasion of the portal
vein or superior mesenteric vessels.

12. PATOLOGY
 Extrapancreatic extensions can involve:
Spleen, stomach , colon splenic flexure ,
left adrenal gland.
 In patients with advanced disease :
liver, lymph nodes and peritoneum are
common.

13. PATOLOGY
PanIN: neoplasias pancréaticas intraepiteliales

14. PATHOGENESIS

15. CLINICAL PRESENTATION
 Most patients have symptoms in a late stage of the disease.
 This makes the diagnosis is delayed and less than 20 % of patients
are candidates for resection of the tumor.
Tumors of the
head : symptoms
at an earlier stage
of the disease
Distal gland
tumors: "SILENT”

16. CLINICAL PRESENTATION
Jaundice
Patients with exocrine
insufficiency
> 50% of
the cases
Steatorrhea and malabsoption syndrome
Abdominal pain
invasion of celiac plexus and the plexus of
the superior mesenteric artery
- Nausea
- Fatigue
- Anorexy
- weightloss
- Mellitus diabetes
- Pancreatitis ( acute pancreatitis
can sometimes be the first
manifestation of CP
#1

17. • Usually asymptomatic
• Signs and nonspecific symptoms
• Advanced stages the prevalence of symptoms depends
on the size, location and tumor metastasis.
DIAGNOSIS

18. SUSPICION OF CANCER IN THE HEAD OF THE PANCREAS
Weightloss92%
Jaundice 82%
Abdominal
pain/ back
pain 72%
Acolia 62%
Coluria 63%
Anorexy 64% Nausea 45%
Threw up 37%
Fatigue 35%
DIAGNOSIS

19. TUMORAL MARKERS
CA 19-9
69-93 % sensitivity and specificity of 78-98 %
CA 125
Detectado en un 50%
DIAGNOSIS

20. TC:
Knowing the extent of
the tumor to nearby
organs and lymph
involvement.
T. Helicoidal:
Method of choice for
the diagnosis and
staging.
- Detects tumors
larger than 2 cm.
- It has 100 %
accuracy for Dx of
unresectable tumor.
Ultrasonography:
Lesions larger than 2
cm.
Assesses the state of
the bile duct and liver
metastases.
Rate resectability.
Allows the realization
of PAF ( cytological ).
DIAGNOSIS

21. CPRE:
When there
cholangitis start .
Unspecific . Allows
cytology of
pancreatic juice.
Gastrointestinal study :
Detects
understanding ,
movement and
invasion .
DIAGNOSIS

22. TNM- AJCC/UICC
STAGING

23. unresectable or borderline
resectable disease
locally advanced
unresectable disease
Disseminated disease

24. TREATMENT

25. Resected 10-20%
survive to 5 years
The majority died
before the year
PROGNOSIS

26. BIBLIOGRAPHY
• Bartlett D, Di Bisceglie A, Dawson L. Cancer of the Liver . En: De Vita,
Hellman, Rosenberg. Cancer, principles & practice of oncology. 10th
edición. Philadelphia: Lippincot Williams; 2012. p. 1129-1156.
• Villalobos, J., Valdovinos, Olivera (2012). Gastroenterología. Méndez
editores. 6ta edición