Pancreatic cancer develops in the pancreas, it is an organ important in digestion and blood sugar regulation.
It is uncontrolled cell growth in the pancreas that can spread to other body parts.
Pancreatic cancer ranks tenth in men and seventh in women. While it is fourth leading cause of cancer deaths in men and third in women.
Pancreas secrets digestive enzymes and hormones for sugar metabolism regulation.
Adenocarcinoma is the most common type which originates in the exocrine cells responsible for production of enzymes in digestion process.
Neuroendocrine tumors arise from the islet cells in the pancreas, which produce hormones such as insulin and glucagon.
Types of Pancreatic Cancer are:
Exocrine Tumors
Neuroendocrine Tumors
Epidemiology
Pancreatic cancer ranks 11th in incidence but 7th as cause of cancer death.
In the US, the peak pancreatic cancer rate was 17.6 cases per 100000 annually in Black men. It is rare in those under 45 years old with no familial or chronic pancreatitis history.
Approximately 90% of diagnosed patients are more than 55 years old with a median age of 70 years.
It is rare but ranks fourth in cancer deaths for both genders in the United States.
Anatomy
Pathophysiology
Majority of pancreatic cancers found in exocrine portion including ductal epithelium, acinar cells, connective tissue, and lymphatic tissue.
Patients show late-stage disease, lymph node involvement, and hypercalcemia. It usually does not spread to the brain.
Pancreatic cancer can spread to lymph nodes, liver, lungs and nearby organs in advanced stages. It can spread to skin with painful nodular metastases.
Cancer cells lose their normal cell adhesion properties and invasive capabilities to allow metastasis.
400 mg/m² of intravenous pyelogram on 1st day, followed by 2400 mg/m² intravenously continuously for 46 hours every 2 weeks
multidrug chemotherapy regimen
For multidrug chemotherapy regimen combined with leucovorin 400 mg/m² intravenous pyelogram on 1st day, followed by 2400 mg/m² intravenously for 46 hours every 2 weeks
Indicated for pancreatic cancer as single agent
1000 mg/m2 intravenously once a week for 3 weeks in a 28-day cycle
It can also be used if combined with paclitaxel, erlotinib, capecitabine)
Indicated for Pancreatic Cancer
Administer the irinotecan liposomal before fluorouracil and leucovorin
70 mg/m² intravenous infusion over 1 hour 30 min every two weeks
Pre-treatment with the antiemetic agent and corticosteroid 30 minutes prior to irinotecan liposomal infusion
It is used in combination with leucovorin and fluorouracil for the metastatic adenocarcinoma of the pancreas following disease progression occurs after gemcitabine-based treatment
Dose modifications
For patients who are homozygous for the UGT1A1*28 alleles: 50 mg/m² intravenous infusion over 1 hour 30 min every two weeks; enhance the dose to 70 mg/m² as well tolerated in following cycles
Adverse reactions in grade 3 or grade 4
Retain the dose
When it reaches grade 1, restart the dose at,
1st occurrence: Restart dose at 50 mg/m² or at 43 mg/m²
2nd occurrence: Restart dose at 43 mg/m² or at 35 mg/m²
For Diarrhea as a side effect: Retain the dose; start loperamide for the late-onset diarrhea; administer intravenous or subcutaneous atropine 0.25 mg-1 mg for the early-onset diarrhea
Indicated as first-line therapy for advanced pancreatic cancer in conjunction with gemcitabine :
On Days 1, 8, and 15 of each 28 days, 125 mg/m2 intravenously was administered over 30 to 40 minutes.
On Days 1, 8, and 15 of each 28-day cycle, administer gemcitabine 1000 mg/m2 intravenously over 30 to 40 minutes directly after paclitaxel protein binding.
Dose Adjustments
First dosage reduction:800 mg/m2 (gemcitabine); 100 mg/m2 (paclitaxel)
Second dose: 600 mg/m2 (gemcitabine); 75 mg/m2 (paclitaxel)
If an extra dosage decrease is needed, discontinue.
Modifications to the dosage (pancreatic cancer – hematologic toxicities)
Day 1 of the cycle: platelets<100,000/mm3 or ANC<1500/mm3 - Postpone dosages until you have recovered.
Day 8 of the cycle: platelets 50,000 to <75,000/mm3 or ANC 500 to <1000/mm3 - Lower 1 dosage level
Day 8 of the cycle: platelets <50,000/mm3 or ANC <500/mm3 - Stop taking dosage
Day 15 of the cycle: platelets 50,000 to <75,000/mm3 or ANC 500 to <1000/mm3 or - Reduce one dosage level from Cycle Day 8
Day 15: platelets<50,000/mm3 or ANC <500/mm3. - Stop taking the dose
Cycle Day 15 (if dosages on Day 8 are skipped): platelets >75,000/mm3 or ANC >1000/mm3 - Reduce one dosage level from Day 1
Cycle Day 15 (if Day 8 doses are skipped): platelets 50,000 to <75,000/mm3 or ANC 500 to <1000/mm3- Decrease two dosage levels from Day 1
Cycle Day 15 (if Day 8 doses are skipped): platelets <50,000/mm3 or ANC <500/mm3. - discontinue usage of dose
Dosage modifications (pancreatic cancer – other toxicities)
Febrile neutropenia (grade 3 or 4): Withhold until temperature subsides and ANC reaches >1500/mm3 - resume at the next reduced dosage level.
Grade 3 or 4 peripheral neuropathy: Withhold paclitaxel until the patient improves to Grade 1, and continue at the next reduced dosage.
Cutaneous toxicity (Grade 2 or 3): Lower the dosage to the next lower level; stop therapy if toxicity continues.
Toxicity of the gastrointestinal tract (Grade 3 mucositis or diarrhea): Withhold until it improves to ≤Grade 1; continue at the next reduced dosage level.
Pancreatic cancer develops in the pancreas, it is an organ important in digestion and blood sugar regulation.
It is uncontrolled cell growth in the pancreas that can spread to other body parts.
Pancreatic cancer ranks tenth in men and seventh in women. While it is fourth leading cause of cancer deaths in men and third in women.
Pancreas secrets digestive enzymes and hormones for sugar metabolism regulation.
Adenocarcinoma is the most common type which originates in the exocrine cells responsible for production of enzymes in digestion process.
Neuroendocrine tumors arise from the islet cells in the pancreas, which produce hormones such as insulin and glucagon.
Types of Pancreatic Cancer are:
Exocrine Tumors
Neuroendocrine Tumors
Pancreatic cancer ranks 11th in incidence but 7th as cause of cancer death.
In the US, the peak pancreatic cancer rate was 17.6 cases per 100000 annually in Black men. It is rare in those under 45 years old with no familial or chronic pancreatitis history.
Approximately 90% of diagnosed patients are more than 55 years old with a median age of 70 years.
It is rare but ranks fourth in cancer deaths for both genders in the United States.
Majority of pancreatic cancers found in exocrine portion including ductal epithelium, acinar cells, connective tissue, and lymphatic tissue.
Patients show late-stage disease, lymph node involvement, and hypercalcemia. It usually does not spread to the brain.
Pancreatic cancer can spread to lymph nodes, liver, lungs and nearby organs in advanced stages. It can spread to skin with painful nodular metastases.
Cancer cells lose their normal cell adhesion properties and invasive capabilities to allow metastasis.
Pancreatic cancer develops in the pancreas, it is an organ important in digestion and blood sugar regulation.
It is uncontrolled cell growth in the pancreas that can spread to other body parts.
Pancreatic cancer ranks tenth in men and seventh in women. While it is fourth leading cause of cancer deaths in men and third in women.
Pancreas secrets digestive enzymes and hormones for sugar metabolism regulation.
Adenocarcinoma is the most common type which originates in the exocrine cells responsible for production of enzymes in digestion process.
Neuroendocrine tumors arise from the islet cells in the pancreas, which produce hormones such as insulin and glucagon.
Types of Pancreatic Cancer are:
Exocrine Tumors
Neuroendocrine Tumors
Pancreatic cancer ranks 11th in incidence but 7th as cause of cancer death.
In the US, the peak pancreatic cancer rate was 17.6 cases per 100000 annually in Black men. It is rare in those under 45 years old with no familial or chronic pancreatitis history.
Approximately 90% of diagnosed patients are more than 55 years old with a median age of 70 years.
It is rare but ranks fourth in cancer deaths for both genders in the United States.
Majority of pancreatic cancers found in exocrine portion including ductal epithelium, acinar cells, connective tissue, and lymphatic tissue.
Patients show late-stage disease, lymph node involvement, and hypercalcemia. It usually does not spread to the brain.
Pancreatic cancer can spread to lymph nodes, liver, lungs and nearby organs in advanced stages. It can spread to skin with painful nodular metastases.
Cancer cells lose their normal cell adhesion properties and invasive capabilities to allow metastasis.
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