The Problem Of Pancreas Adenocarcinoma With Complete Encasement Of The Superior Mesenteric Artery And Vein

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Problem Pancreas adenocarcinoma with complete encasement of the superior mesenteric artery and vein. AJCC stage III, T4 Nx M0. Definition • Fourth most common cancer mortality cause in USA.1 • Contributes to 3% estimated new cancer each year in USA, contributing to 44, 030 new diagnosis and 37, 660 expected deaths in 2013.1 • Most aggressive cancer with less than 2% 5 years survival.1 • Clinical staging o Stage I or II – surgically resectable.2 o Stage III – localy advanced, unresectable.2 o Stage IV – metastatic.2 Sign and symptoms • Abdominal pain.2 • Weight loss.2 • Asthenia.2 • Anorexia.2 • Jaundice.2 Diagnostics • Best initial diagnostic test using tri-phasic pancreatic-protocol CT.3 • Endoscopic ultrasound.2, 3 • MRI.3 • Monitor tumour markers carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9). Both has no specificity or sensitivity to be used in screening but can be useful for monitoring patient with known pancreatic cancer.2 Risk factors • Genetic/family history.2, 3 • Smoking.2, 3 • Long-standing diabetes mellitus.2, 3 • Nonhereditary or hereditary chronic pancreatitis.2 • Obesity.2, 3 • Non-O blood group.2 • Occupational exposures.3 • High fat diet.3 Complication • Poor survival rate upon diagnosis. 90% patient pass away within 1 year being diagnosed.4 • Physiological impact, may cause depression,4 anxiety5. • Affect quality of life (QOL).4 • Metastasis and invasion to another parts of the body.2 Options Pharmaceutical regimen • FOLFIRINOX o

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