PANCREAS

CARCINOMA
SGD B06

INTRODUCTION
PANCREAS CARCINOMA

ANATOMY OF
PANCREAS
Pancreas is a retroperitoneal organ
Divided into 4
parts:
Head
Neck
Body
Tail

Pancreas has two

main function:
Endocrine and
exocrine

PANCREAS
CARCINOMA
Cancer are cells that escaped the normal control
mechanism (eg. Cell growth, Apoptosis)
Pancreas carcinoma affecting the
function:
Exocrine (95%) it can be in ductal epithelium, acinar cells,
connective tissue, and lymphatic tissue
Endocrine functional

EPIDEMIOLOGY
GLOBAL DATA
8/100.000 incidence
10th most common cancer in
MEN
th
11 most common cancer in
WOMEN

4th LEADING CAUSE OF

DEATH
96% MORTALITY RATE

MORE COMMON in median

Age 72 y.o

2-3 FOLDS HIGHER in Black

Population

ETIOLOGY
PANCREAS CARCINOMA

ETIOLOGY

SMOKING
Carcinogenic
ingredients
causing
inlfamation ,
fibrosis, and
cell
proliferation

GENETICS
Mutation in
Oncogene
KRAS
Incativation
Tumor
Supressor
Gene
Telomere
shortening

DIET &
OBESITY
Especially RED
MEATS and
OBESITY is
risk for
Pancreas
carcinoma

OTHER
MEDICAL
CONDITION
Chronic
Pancreatitis
(26 FOLDS
HIGHER)
Diabetes
Melitus type 2

PATHOGENESIS
PANCREAS CARCINOMA

PATHOGENESIS
NORMAL

PanIN1A

PanIN1B

PanIN-2

PanIN-3

INVASIVE
CARCINO
MA

PATHOGENESIS
KRAS ONCOGENE
(80-90% cases)

Impair the intrinsic GTPase activity of

the KRAS protein
KRAS activates a number of
intracellular signaling pathways (KRAS
effectors) that promote
carcinogenesis

CDKN2A
(95% cases)

Inactivation of this tumor supressor

gene will removes an important
checkpoint in cell cycle control

PATHOGENESIS
TP53 Tumor
Supressor Gene
(50-70% cases)

SMADA4 Tumor
Supressor
(55% cases)

Absence of p53 protein that will cause

enforce cell cycle checkpoints and as
an inducer of apoptosis or senescence

Coding for a protein that plays role in

signal transduction downstream of the
transforming growth factor- receptor

ALL OF THOSE GENETIC MUTATION WILL LEAD INTO

UNCONTROLLED PROLIFERATION OF PANCREAS CELL

PATHOGENESIS
90% of pancreatic cancer originates from the exocrine tissue of
pancreatic ductal adenocarcinoma

Location:

70% of pancreatic cancer occur in

the head
20% in the body
10% in the tail pancreas

Entire omental and portahepatic lymph nodes FREQUENTLY

are involved and the liver often is enlarged as consequence of
metastasic deposits

CLINICAL
FEATURES
PANCREAS CARCINOMA

CLINICAL FEATURES

WEIGHT
LOSS

LOSS OF
APPETITE

FATIGUE
AND
MALAISE

JAUNDICE/ ICTERIC MIGHT HAPPEN

ABDOMIN
AL AND
BACK
PAIN

DIAGNOSIS
PANCREAS CARCINOMA

DIAGNOSIS
Based on: Anamnesis + Physical Exam + Supporive
Exam
Trias of Pancreas
Carcinoma

Abdominal pain
Jaundice
Weight Loss

Physical Examination

Courvoisier sign
(+)
Migratory
Thrombophlebitis

DIAGNOSIS
LABORATORY
CA 19-9

DIAGNOSIS
SUPPORTIVE EXAMINATION: IMAGING

USG

EUSFNA

CTSCAN

DIAGNOSIS
SUPPORTIVE EXAMINATION: HISTOPATHOLOGY

Macroscopi
c

Microscopic

DIAGNOSIS
STAGING OF PANCREAS CARCINOMA
STAGE

Tis

N0

M0

IA

T1

N0

M0

IB

T2

N0

M0

IIA

T3

N0

M0

IIB

T1,T2,T3

N1

M0

III

T4

N0 or N1

M0

IV

T1,T2,T3,T4

N0 or N1

M1

DIFFERENTIAL
DIAGNOSIS
PANCREAS CARCINOMA

DIFFERENTIAL
DIAGNOSIS

ABDOMINAL AORTIC
ANEURYSM (AAA)

AMPULLARY
CARCINOMA (AC)

INTESTINAL ISCHEMIA
(II)

MANAGEMENT
PANCREAS CARCINOMA

MANAGEMENT
Determine

Resectable

Borderline

Unresectable

Using criteria for determining lession

resectability to decide whether the lession is
resectable, borderline, or unresectable
Immediate surgery with/ without adjuncvant
chemotherapy
Type of surgery:
Pancreaticoduodenectomy for tumor in
head of pancreas
Still new categories
Adjuvant chemotherapy to make the lession
smaller
Then do the surgery + adjuvant
chemotherapy
Can not do the surgery, only do the
chemotherapy/ radiation + paliative
Adequate nutrition
Pain control
Biliary stenting

MANAGEMENT
DETERMINE

MANAGEMENT
RESECTABLE

Pancreoduodenectomy

MANAGEMENT
Chemotherapy
Gemtacibine
5-FU

+
Pancreoduodenectom
y

BORDERLINE
RESECTABLE

MANAGEMENT
CHEMOTHERAPY
Gemtacibine
Gemtacibine with
other chemotherapy
agent (5FU)

+
PALLIATIVE
Adequate nutrition
Pain control
Biliary stenting

UNRESECTABLE

PROGNOSIS
PANCREAS CARCINOMA

PROGNOSIS

SUMMARY
PANCREAS CARCINOMA

SUMMARY
Pancreatic cancer begins when cells in the pancreas
start to grow uncontrollably
Pancreatic cancer caused by the mutations of the
DNA.
The risk factors are family history and genetic
factors, smoking, the diet and obesity, and other
medical conditions such as diabetes mellitus type 2
and chronic pancreatitis.

SUMMARY
The pathogenesis of the pancreatic cancers are
mutational activation of the KRAS oncogene,
inactivation of tumor-suppressor genes, widespread
chromosomal losses, gene amplifications, and
telomere shortening
Three main symptoms of pancreatic cancer which is
pain, loss of weight, and jaundice
The diagnosis based on:
Anamnesis + Physical Exam + Supporive Exam

SUMMARY
Two types of the management for pancreatic
cancer :
1. Prevention therapy by healthy diet, limited
alcohol consumption and smoking
2. Curative therapy by resection, chemotherapy,
and radiotherapy
They key factors relating to prognosis are TUMOR
GRADE, THE DIAMETER, AND LYMPH NODE
STATUS.

THANK YOU
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