Neoplasms_of_the_Exocrine_Pancreas

Neoplasms_of_the_Exocrine_Pancreas - Neoplasms of the...

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Neoplasms of the Pancreas Vic V. Vernenkar, D.O. St. Barnabas Hospital Dept. Of Surgery From Greenfield’s Surgery 2006 4 th edition
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Introduction Estimates:33000 cases, 32000 die in 2005. 4 th leading cause of cancer death. Non-specific symptoms, inaccessibility to examination, aggressiveness, technical difficulties associated with surgery.
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Epidemiology/Risk Factors Increase threefold since the beginning of the century. Age, race, sex, tobacco, diet, specific genetic syndromes. More than 80% of cases between 60-80 years of age, rare under 40. African-American of both sexes
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Epidemiology/Risk Factors Men over women Cigarette smoking increased risk 1.5-5 times. Increased consumption of total calories, CHO, cholesterol, meat, salt, fried food, refined sugar, soy beans, nitrosamines.
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Epidemiology/Risk Factors A protective effect for dietary fiber, vitamin C. fruits and veggies. Long standing diabetes is not a risk factor.
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Epidemiology/Risk Factors Chronic pancreatitis of any cause has been associated with a 25-year cumulative risk of 4%. Other conditions for which a possible connection to pancreatic cancer are: thyroid cancer, cystic fibrosis, pernicious anemia. Most cases of pancreatic cancer have no predisposing factors, however it is estimated that between 5-10% arise because of a familial disposition.
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Epidemiology/Risk Factors Six genetic syndromes associated with an increased risk of pancreatic cancer are: HNCC, BRCA-2 associated familial breast cancer, PJ syndrome, ataxia-telangietasia, hereditary pancreatitis, familial mole- melanoma syndrome.
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Molecular Genetics Tumor suppressor genes : p53, p16, DPC4, BCA2. P53 is inactivated in 75% of all pancreatic cancers.
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Molecular Genetics DPC4 is on Chromosome 18q. The Chromosome is missing in 90% of all pancreatic cancers, the gene inactive in 50%. The mutations are more specific for pancreatic cancer than p53 or p16 mutations. Oncogenes , when over expressed encode proteins with transforming qualities. Activating point mutations in the k-ras oncogene is the most common genetic alteration in pancreatic cancer, found in 80-90% of pancreatic cancers.
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Pathology Classified based on cell of origin. Most common are ductal adenocarcinomas . 65% of ductal cancers arise in the head, neck, or uncinate process; 15% originate in the body or tail; 20% diffuse.
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Solid Epithelial Tumors Adenocarcinomas : 75%, white yellow, poorly defined, often obstruct bile duct or main pancreatic duct. Often associated with a desmoplastic reaction that causes fibrosis and chronic pancreatitis.
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Solid Epithelial Tumors Infiltrate into vascular, lymphatic, perineural spaces. At resection, most mets to lymph nodes. Mets to liver (80%), peritoneum (60%), lungs and
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Neoplasms_of_the_Exocrine_Pancreas - Neoplasms of the...

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