Pancreatic Tumors: A Case Study

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There is another classification of pancreatic tumor help in decision making of management. This classification depends on the possibility of surgical removal of the tumor: in this way, tumors are judged to be "resectable", "borderline resectable" or "unresectable" (American Cancer Society, 2014).
AJCC stages I and II defines the disease without spread to large blood vessels or distant organs such as the liver or lungs with possibility of surgical resection of the tumor (Bond-Smith et al., 2012).
The AJCC staging system allows distinction between stage III tumors that are judged to be "borderline resectable" (where surgery is technically feasible because the celiac axis and superior mesenteric artery are still free) and those that are "unresectable"
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Table (4): Criteria of defining respectability status. Resectable Borderline resectable Unresectable
Venus Patent superior mesenteric vein (SMV) and portal vein Severe SMV impingement or reconstructable SMV occlusion Unreconstruble SMV/portal vein occlusion
Arterial Clear fat plane around celiac artery and SMA Less than 180° abutment of SMA.
Reconstructable encasement of SMA.
Reconstructable abutment or encasement of hepatic artery. Greater than 180°SMA encasement. Unreconstructable SMA involvement.
Any celiac abutment (head mass) Greater than 180° SMA encasement (body mass) Aorta Aortic invasion or encasement
Metastasis No distant metastases Distant metastases to LN beyond field of resection

There are several prognostic factors can be detected in patients with locally advanced or metastatic pancreatic cancer, these factors includes:
(a) Grading of the tumor: is very important prognostic factor, well differentiated tumors are associated with better OAS than poorly differentiated tumors (Wasif et al.,
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Badger et al., in 126 surgically resected pancreatic cancer patients, showed that lymphatic vascular and perineural invasion, together with the grading, are important predictors of outcome and their presence is associated with a reduced survival (Badger et al ., 2010).
In particular, perineural invasion has a crucial role in the local recurrence of disease after surgery. Perineural space is known to be an important route of pancreatic cancer invasion. Pancreatic cancer cells invade the neural plexus distributed in pancreatic parenchyma and spread through perineural space to reach extra-pancreatic nerves, such as the celiac plexus or the supra-mesenteric artery plexus. Cancer cell invasion into the neural plexus often results in non-curative resection and, therefore, retroperitoneal recurrence (Kenmotsu, 1990, Kameda et al., 1990).
(d) CA19-9, CEA: has also importance in the prognosis of cancer pancreas (Blumenthal et al., 2005). Studies showed that patients who present a significant increase of CA19-9 at the time of diagnosis or onset of chemotherapy, have a reduced survival compared to those in which the marker is normal (Maisey et al.,
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