Martina Rastovac Mentor: A. Žmegač Horvat

Actor Patrick Swayze died after a 20-month battle with pancreatic cancer. He was 57.Patrick Swayze

Epidemiology: –< 2% of all malignancies – ~ 6500 deaths/year Typical patient: –male > 60yrs old Risk factors: – smoking – alcohol – carcinogens – chronic pancreatitis

Pancreas: –head –body –tail

Symptoms & signs: –jaundice –pain in the upper or middle abdomen and back –unexplaind weight loss –loss of appetite –fatigue

Investigations: –transabdominal ultrasound –contrast-enhanced spiral CT scan –laparoscopy –ERCP –percutaneous needle biopsy –MRI scanning and endoscopic ultrasound –several tumour markers (CA19-9)

Pathology: –mostly ductal adenocarcinoma (metastasizes early; presents late) Location of tumor: - 60% head - 25% body - 15% tail

Stages of pancreatic cancer: I II III IV

Treatment: –surgery Whipple`s procedure total pancreatectomy distal pancreatectomy –radiation therapy –chemotherapy

Whipple`s procedure:

WHO Pain relief ladder Freedom from cancer pain

Prognosis: –dismal Mean survival: < 6 months 5yr survival: < 2 % After Whipple`s procedure: 5-14% Better if: tumour < 3 cm no nodes involved negative resection margins at surgery ampullary or islet cell tumors

References: Longmore, Oxford Handbook of Clinical Medicine, Oxford University Press, 2010