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What are the patient and tumour factors to consider in the management of pancreatic cancer?
- Patient: age, functional status, co-morbidities, wishes
- Tumour: stage (CT, MRI, endoscopy, laparotomy), resectability (mets, vaculature invasion), size, resection margins
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What is the criteria for resectability in pancreatic cancer?
- NO extra-pancreatic mets
- NO occlusion or encasement of portal-mesenteric vasculature (SMA/SMV, aorta, portal v., celiac plexus)
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What is the surgery for the removal of pancreatic cancer?
- +/- pre-op ERCP biliary decompression
- Standard pancreaticoduodenectomy (Whipples procedure): removes pancreatic head, duodenum, CBD, gallblader... etc.
- May be variations of the procedure
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How is adjuvant chemoradiotherapy used in pancreatic cancer?
Used for locally advanced pancreatic cancer that's not distally metastatic!
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Describe the palliation issues for patients with met. pancreatic cancer (8 issues).
- Pain: opioids, celiac plexus block, radiotherapy
- N & V: anti-emetics
- Obstructive jaundice: biliary decompression (usually endoscopic instead of surgery bypass)
- Gastric outlet obstruction: open gastro-jejunostomy
- Pancreatic insufficiency: lipase & protease replacement
- DM: insulin
- Depression: psych r/v
- Palliative chemotherapy: prolonged survival and improved QoL in 30% of pts
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