Problem
Pancreas adenocarcinoma with complete encasement of the superior mesenteric artery and vein. AJCC stage III, T4 Nx M0.
Definition
• Fourth most common cancer mortality cause in USA.1
• Contributes to 3% estimated new cancer each year in USA, contributing to 44, 030 new diagnosis and 37, 660 expected deaths in 2013.1
• Most aggressive cancer with less than 2% 5 years survival.1
• Clinical staging o Stage I or II – surgically resectable.2 o Stage III – localy advanced, unresectable.2 o Stage IV – metastatic.2
Sign and symptoms
• Abdominal pain.2
• Weight loss.2
• Asthenia.2
• Anorexia.2
• Jaundice.2
Diagnostics
• Best initial diagnostic test using tri-phasic pancreatic-protocol CT.3
• Endoscopic ultrasound.2, 3
• MRI.3
• Monitor tumour markers carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9). Both has no specificity or sensitivity to be used in screening but can be useful for monitoring patient with known pancreatic cancer.2
Risk factors
• Genetic/family history.2, 3
• Smoking.2, 3
• Long-standing diabetes mellitus.2, 3
• Nonhereditary or hereditary chronic pancreatitis.2
• Obesity.2, 3
• Non-O blood group.2
• Occupational exposures.3
• High fat diet.3
Complication
• Poor survival rate upon diagnosis. 90% patient pass away within 1 year being diagnosed.4
• Physiological impact, may cause depression,4 anxiety5.
• Affect quality of life (QOL).4
• Metastasis and invasion to another parts of the body.2
Options
Pharmaceutical regimen
• FOLFIRINOX
o
There are not many defined risk factors known for pancreatic cancer. Some risk factors are “family history of the disease, smoking, age, and diabetes (Mayoclinic).” Ideally, pancreatic cancer cells can be detected early and the patient can be treated surgically, but once the cancer has spread, it is usually incurable. A popular clinical tool used to detect pancreatic cancer “is a tumor marker called sialylated Lewis blood group antigen CA19–9, which can act as a sensitive tumor marker, value diminishes when used to detect small, resectable tumors (Maitra,
CA 19-9 is a type of tumor marker for pancreatic cancer. It mostly used to help in differentiating between pancreatic cancer and other conditions which include pancreatitis, monitor, to monitor patient’s response to the treatment of pancreatic cancer or cancer progression and to watch for the recurrence of pancreatic cancer (Hui et al., 2015).
The CDC estimates that each year, more than eight million people are diagnosed, and consequently died from cancer, and this statistic was even higher in the 1950s. During this period, little was known of cancer’s effects on the
Malignant Peritoneal Mesothelioma is neoplasm arising from the serosal lining of the peritoneal and pericardial cavities. Primary tumors arising from the peritoneal mesothelioma are extremely rare. The accurate diagnosis of the diffuse peritoneal mesothelioma is important because it almost invariably has a fatal outcome. In many cases, malignant peritoneal mesothelioma is not diagnosed until after surgery or autopsy. The distinction of the malignant peritoneal mesothelioma from tumors metastatic to the serosal membranes can often be made based on the results of histochemical studies.
According to Professor John Neoptolemos, "There are approximately 7,000 new cases each year - but it is one of the most lethal cancers." The main reason for the low survival rate from pancreatic cancer is due to its difficulty in finding this cancer early. By the time a person has symptoms, the cancer has often reached a large size and spread to other organs. Because the pancreas is deep inside the body, the doctor cannot see or feel tumors during a routine physical exam. There are currently no blood tests or other tests that can easily find this cancer early in people without symptoms. Tests for certain genes in people with a family history of the disease can help tell if they are at higher risk for cancer. There are some new tests for finding pancreatic cancer early in people with a strong family history of the disease, but these tests are complicated and expensive. Some symptoms of pancreatic cancer include jaundice, a yellow color of the eyes and skin caused by a substance buildup in the liver, pain in the belly area or in the middle of the back, significant weight loss over a number of months, loss of appetite, digestive problems including nausea, vomiting, pain that tends to be worse after eating, a swollen gallbladder that is enlarged, blood clots that form in the veins or cause problems with fatty tissue under the skin, and diabetes. If the doctor has any reason to suspect pancreatic cancer, certain tests will be done to see if the disease is really
Cancer is the main cause of death in the world, estimating 8.2 million fatalities in 2012 alone
Cancer affects everyone – the young and old, the rich and poor, men, women and children – and represents a tremendous burden on patients, families and societies. Cancer is one of the leading causes of death in the world, particularly in developing countries.
The aim of this review is to give an account of the second leading cause of death in the United States of America. The review described the origin of cancer, its nature, prevention strategies and treatment. It also evaluated the concept used by the author.
Pancreatic Cancer starts in the tissues of the pancreas.To give a vivid image of the pancreas, it is a six-inch spongy shaped organ. Some people say it is shaped
When spreading through the body there are certain stages the cancer has to go through to expand. Stage 0. There is no spread.The cancer is limited to only one cell in the pancreas. Stage I: The cancer is only limited to the pancreas cell, but has moved at least two centimeters. Not yet visible in screening tests. Stage II: The cancer has grown outside the pancreas and may have spread to the lymph nodes. Stage III: The tumor has spread drastically making it now possible for the tests to detect the tumor,increasing the possibility for it expand into the blood vessels or nerves. Stage IV: The cancer has spread to different organs of the body.("Pancreatic Cancer Treatments by Stage") The first place to attack after spreading would be the stomach, then it would expand to the liver. After the cancer reaches these points, it travels to other places in the body. ("Treating Pancreatic Cancer, Based on Extent of the Cancer").
My patient is a 64-year-old that came in for upper abdominal pain. She felt her pain was worse when she lied down flat, so she had been trying to sit up and lean forward for most of the day. As the day went on her pain got worse, so she came into Emergency Department for further evaluation. She did not have any nausea or emesis and no change in her bowel habits. No fevers or chills. No trauma to the abdomen. In the hospital, she is diagnosed with acute pancreatitis.
Abdominal ultrasound is sometimes used for quick and cheap first examinations. If there is uncertainty about the diagnosis they may do a biopsy by fine needle aspiration. Pancreatic cancer is usually staged after a ct scan is done. The staging system is four stages,from early to advanced and based on TNM classification.TNM stands for Tumor size, spread to lymph nodes,and metastasis. Based on if surgical removal seems possible,the tumors are divided into three broader categories to help decide treatment. Tumors are resectable, borderline resectable or undetectable. If the disease is still in an early stage(stage 1 or 2) surgical resection of the tumor can be performed. Stage 3 tumors can be borderline resectable where surgery can technically still be done or unresectable where its to locally advanced. Stage 1 cancer is only found in the pancreas. Stage 1 is divided into a and b stages based on tumor size. Stage 1a is when the tumor is no bigger than 2 cm. Stage 1b is when the tumor is bigger than 2 cm. The second stage is when the cancer could have spread to nearby tissue and organs, and may have also spread to the lymph nodes near the
Currently, the clinical avail of CTCs analysis remains debatable in the PC. To date, numerous analysts have attempted to identify CTCs in patients with PC and have shown its potential clinical utility utilizing different methodologies and with varying results (Table 1) [84, 180-190]. Notably, some studies showed that CellSearch™ has a lower CTCs detection rate for PC patients with the sensitivity and specificity of 55.5 % and 100 %, respectively. Additionally, these studies also revealed that CTCs could only be found in malignant pancreatic tumor and CTCs positive patients have a significantly shorter overall survival. However, CTCs detected in these studies failed to correspond with tumor stage [84, 180, 182, 190]. Interestingly, in a
Carcinoembryonic antigen (CEA) is a tumor marker that can be detected in the blood of clients with colorectal cancer. CEA level is used to estimate prognosis, monitor treatment, and detect cancer recurrence.