PANCREATIC CANCER

I. Risk factors for pancreatic cancer

1. Family history
2. Peutz-Jeghers syndrome
3. Chronic pancreatitis (possibly)

II. Diagnosis of pancreatic cancer

1. Tissue diagnosis (e.g. by endoscopic-guided fine-needle aspiration) is not always feasible and in some cases of suspected pancreatic Ca a decision whether or not to perform a pancreatic resection may need to be made without the benefit of a tissue diagnosis.
2. In a prospective study in 150 pts undergoing surgery for suspected pancreatic Ca, multivariate analysis showed that the following had 100% specificity for an eventual diagnosis of pancreatic Ca (regardless of imaging results): weight loss of > 20 pounds, serum bilirubin > 3 mg/dL, and CA 19-9 level > 37U/mL (Am. J. Surg. 191:191, 2006--JW)

III. Staging of pancreatic cancer (preoperatively):

1. Endoscopic ultrasound is superior to standard CT for detection and local staging, but CT may be superior for detecting hepatic and distant metastases, though with multidetector CT this gap may not be significant.  Also, both modalities may miss some lesions.

IV. Treatment of pancreatic cancer

1. Anti-androgens for tx of pancreatic cancer: 49 pts with pancreastic Ca randomized to flutamide vs. placebo; 1y survival rates were 50% with flutamide and 5% with placebo (BMJ 316:1935, 1998--JW)
2. Adjuvant chemotherapy after surgical resection of pancreatic cancer:
   1. In a study of 289 pts s/p complete macroscopic resection of pancreatic adenocarcinoma randomized to post-op chemo, chemo-radiotherapy, both, or neither, after median 47mos, composite analysis of both chemoradiotherapy groups vs. the pts who didn't receive chemoradiotherapy showed sig. shorter median survival (16mos vs. 18mos) in the former; composite analysis of chemotherapy vs. non-chemotherapy groups showed sig. greater median survival (20mos vs. 15.5mos) in the former (European Study Group for Pancreatic Cancer study, NEJM 350:1200, 2004--JW)