{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 26, Ep 5 of 5: Pancreatic Adenocarcinoma and Neuroendocrine Tumors","html":"","width":"100%","height":180,"duration":915,"description":"Episode five closes the chapter with two tumors that share the same pancreas and almost nothing else. Adenocarcinoma is desmoplastic, poorly enhancing, presents late with painless jaundice, and is staged by its relationship to four vessels into the resectability categories that drive surgery-versus-systemic-therapy. The neuroendocrine tumors are islet-derived, hypervascular, and often announce themselves with a hormone syndrome while still small, sorted by functional pattern and grade. The same core biopsy and multiphase CT serve both, but everything downstream diverges, so the work is holding the two algorithms apart. Biology sets the staging language, and the staging language sets the treatment, from neoadjuvant FOLFIRINOX to somatostatin analogs and radionuclide therapy.\n \nTopics covered\n\nAdenocarcinoma biology and late presentation\nRisk factors: modifiable, hereditary, conditioning\nDiagnostic sequence and core biopsy\nThe autoimmune pancreatitis mimic trap\nFour-vessel resectability staging\nNeoadjuvant, adjuvant, and metastatic chemotherapy\nNeuroendocrine tumor biology and imaging\nFunctional syndromes: insulinoma and gastrinoma\nVIPoma, glucagonoma, somatostatinoma\nTreatment stratified by size and receptor status\n \n \nKey decisions\n\nA patient over sixty with a painless head mass and obstructive jaundice has adenocarcinoma until proven otherwise, so a mildly elevated IgG4 does not justify empiric prednisone that would cost the curative window.\nResectability is defined by the tumor relationship to the celiac axis, common hepatic artery, superior mesenteric artery, and superior mesenteric and portal veins, with borderline disease showing arterial contact under one hundred eighty degrees or reconstructable venous involvement.\nBorderline resectable and many resectable patients receive neoadjuvant modified FOLFIRINOX for four to six months before re-staging, and upfront-surgery patients receive adjuvant modified FOLFIRINOX when fit.\nMetastatic disease is treated with...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}