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15 - Management of cancer of the exocrine pancreas
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- By Rhian Sian Davies, Velindre Cancer Centre, Velindre Hospital, Cardiff, UK, Sarah Gwynne, South West Wales Cancer Centre, Singleton Hospital, Swansea, UK, Somnath Mukherjee, Oxford Cancer Centre, Oxford, UK
- Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
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- Book:
- Practical Clinical Oncology
- Published online:
- 05 November 2015
- Print publication:
- 19 November 2015, pp 212-223
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- Chapter
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Summary
Introduction
Pancreatic cancer is the fifth commonest cause of cancer mortality in the UK. The major risk factors include smoking, diet and a history of previous total gastrectomy. There is also an association between long-standing diabetes and pancreatic cancer. Surgery is the only curative option, but fewer than 20% of patients are suitable for this. Chemotherapy is the mainstay of treatment for fit patients with advanced or metastatic cancers. Chemoradiation is an option for locally advanced inoperable (LAPC) or borderline resectable disease. Palliative care and psychosocial support are important in the management of this challenging disease.
Types of pancreatic tumour
Benign cysts can be congenital and arise from anomalous development of the pancreatic ducts. Pseudocysts are loculated collections of fluid arising from necrosis, inflammation or haemorrhage, which usually occur as a complication of acute pancreatitis. They are often solitary, can measure 5–10 cm and are often found adjacent to the pancreas in the region of the tail. Benign cystadenomas occur in elderly women and are found incidentally at autopsy or during other investigations. Microcystic and papillary–cystic are other variants found in younger women. The types of pancreatic tumour are shown in Table 15.1.
Incidence and epidemiology
There are about 8800 new cases of pancreatic cancer in the UK each year and 8700 die from the disease. The annual incidence is 9.7/100,000; peak incidence occurs for men in their eighth decade and women in their ninth decade.
Pancreatic cancer is the fifth leading cause of cancer death overall (5% of cancer mortality). The incidence is roughly equal in males and females. Most cases of the disease (80%) occur in the head of the pancreas.
Carcinoma of the exocrine pancreas
Risk factors and aetiology
Three per cent of pancreatic cancers may be inherited. Cancer family syndromes include inherited chronic pancreatitis, inherited diabetes mellitus and ataxia telangectasia syndrome.
Cigarette smoking doubles the risk. More than 1 in 4 pancreatic cancers in the UK are caused through smoking. The use of smokeless tobacco also increases the risk.
A diet rich in protein and carbohydrates and poor in fruit and fibre increases the risk of pancreatic cancer; processed meat may increase the risk.
20 - Management of cancer of the kidney
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- By Rhian Sian Davies, Velindre Cancer Centre, Velindre Hospital, Cardiff, UK, Jason Lester, Velindre Cancer Centre, Velindre Hospital, Cardiff, UK, John Wagstaff, Singleton Hospital, Swansea, UK
- Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
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- Book:
- Practical Clinical Oncology
- Published online:
- 05 November 2015
- Print publication:
- 19 November 2015, pp 293-303
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- Chapter
- Export citation
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Summary
Introduction
Cancer of the kidney represents 4% of adult malignancies. Men are more frequently affected than women, and it commonly occurs between the ages of 50 and 70 years. More than 30% of patients present with metastatic disease. The majority of malignant tumours are adenocarcinomas, arising from the proximal renal tubular epithelium. These tumours were previously called hypernephroma because it was believed that they originated from adrenal rests, but they are correctly termed renal cell carcinoma (RCC). The main focus of this chapter is the management of RCC. Transitional cell carcinoma of the renal pelvis accounts for 5% of all renal malignancies, and is covered separately at the end of the chapter.
Types of kidney tumour
Kidney tumours can be benign, malignant primary or metastatic. Benign tumours include cysts (simple, complex, multiple), inflammatory (infection, infarction), adenoma and oncocytoma. Malignant primary tumours include RCC, lymphoma, sarcoma and renal pelvis tumours (5% of malignant renal cancers arise from the renal pelvis, and more than 90% of these are transitional cell carcinoma).
Anatomy
The kidneys are retroperitoneal structures that lie between the eleventh rib and the transverse process of the third lumbar vertebral body, each approximately 11 cm in length, the right lying slightly lower than the left. Each kidney is surrounded by perinephric fat which in turn is covered by Gerota's fascia. The right kidney abuts the liver and stomach and the left, the spleen, stomach and pancreas. The lymphatics drain along the renal vessels, on the right draining to paracaval and aortocaval nodes, and on the left to the para-aortic region.
Incidence and epidemiology
Over 10,000 new cases of kidney cancer were diagnosed in the UK in 2011 resulting in approximately 4200 deaths (Cancer Research UK website accessed July 2014). In the last 10 years kidney cancer incidence rates in the UK have increased by almost a third, and unlike in some other cancers, the death rate is still rising. Kidney cancer occurs most commonly in people 50–80 years of age. Men are more frequently affected than women; the male-to-female ratio is 5:3. It is the seventh most common cancer in men and tenth most common cancer in women in the UK.