Pancreatic Cancer FRCR CO2A Flashcards
(165 cards)
1
Q
what’s the peak age incidence for pancreatic cancer?
A
- male eighth decade
- female ninth decade
2
Q
what subsite of pancreas is frequently affected by pancreatic cancer?
A
Head 80%
3
Q
What are RF for pancreatic cancer?
A
- 3% inherited
- Cigarette smoking, doubles the risk
- Diet rich in protein and carbs and poor in fruit and Vegetables
- toxins like 2-naphthylamine, benzidine and DDT
- long standing DM I and II
- Chronic pancreatitis
- obesity
- Total Gastrectomy (2 to 5 x)
4
Q
What’s the MC pathology of pancreatic cancer?
A
Ductal Adenocarcinoma (90%)
others: acinar, anaplastic, cysadenocarcinoma, sq cell, sarcoma
NEUROENDOCRINE Tumors
5
Q
Where does pancreas lie in human body?
A
Retroperitoneal Structure, infront of 1st and 2nd Lumbar vertebrae
6
Q
How many parts pancreas have?
A
4
Head, Neck, Body and Tail
7
Q
where does pancreatic duct open?
A
pancratic duct combines with CBD and opens in the ampulla of vater
8
Q
what’s the lymphatic drainage of pancreas?
A
- pancreaticoduodenal
- suprapancreatic
- pyloric
- pancreaticosplenic nodes
Drain into Coeliac and superior Mesenteric nodes
9
Q
what causes severe pain in pancreatic cancer?
A
involvement of 1st and 2nd Coeliac ganglia, leading to back pain
10
Q
what structures involvement leads to inoperable pancreatic cancer?
A
Vessels like SM Vessels, portal vein, splenic vein, Celiac artery and its branches
11
Q
what’s the typical s/s of pancreatic cancer?
A
sudden onset painless jaundice
12
Q
what are S/S of pancreatic cancer?
A
- GOO (duodenal spread)
- Obst Jaundice
- Cholangitis
- Steatorrhoea
- Back pain
13
Q
what are s/s of metastatic pancreatic cancer?
A
- Jaundice (extensive liver mets)
- abdominal pain and ascites
- Blumer’s shelf
- SOB (Pulm mets), always exclude PE
- Virchow’s node
14
Q
what is blumer’s shelf?
A
peritoneal metastasis in Pouch of Douglas, which can be palpated rectally
15
Q
what is virchow’s node
A
malignant left Supraclavicular node
16
Q
What paraneoplastic syndromes are a/w pancreatic cancer?
A
- migratory thrombophlebitis (Trousseau’s sign)
- Weber Christian (Subcut fat necrosis, polyarthralgia, eosinophilia)
- dermatomyositis/polymyositis
17
Q
what are constitutional symptoms of pancreatic cancer?
A
- fatigue
- wt loss
- anorexia
- Venous TE
18
Q
what blood tests are advised in pancreatic cancer?
A
CBC/LFT/KFT/Coagulation profile
CA 19.9
19
Q
what imaging is advised for pancreatic cancer?
A
Dual phase helical CT scan
Arterial phase: show the pancreas
Venous phase: look for liver mets
ERCP useful in obstructive jaundice: endobiliary stent placement, brushings
EUS
20
Q
How is EUS useful in pancreatic cancer?
A
- to assess vascular involvement
- obtaining a biopsy, especially in pts with a small tumor in whom standard US or CT guided biopsy may be difficult
21
Q
is tissue proof necessary before starting Rx for pancreatic cancer? and if yes why?
A
yes, radiologically difficulty to distinguish between chronic pancreatitis from carcinoma and CA 19-9 may be elevated in obstructive jaundice
sometimes diagnosis like NET could be missed
22
Q
what is Rx of resectable pancreatic cancer?
A
Radical surgery followed by chemotherapy
23
Q
role of post op crt in pancreatic cancer
A
controversial, practised in USA
24
Q
Goal of surgery in localized pancreatic cancer
A
negative margin
25
what surgery in done for pancreatic cancer?
Pancreatico-Duodenectomy (whipples') or pylorus preserving Pancreatico duodenectomy for Head, Neck and uncinate process
26
what Sx is done for pancreatic cancer in tail and body of pancreas?
distal pancreatectomy
27
what's morbidity and mortality rate of whipples at high volume centre?
morbidity: 40%
mortality: 2.4%
28
Complications of whipple's surgery
1. delayed gastric emptying
2. pancreatic fistula
3. sepsis
4. H'ge
5. malabsorption
6. diabetes mellitus
29
What's standard adjuvant treatment for pancreatic cancer?
mFOLFIRINOX
GemCap
30
what's the role of post op CRT in pancreatic cancer?
GERCOR, failed to demonstrate benefit
31
what are borderline resectable tumors?
1. u/l or b/l SMV or Portal vein infringement
2. < 50% abutment of circumference of SMA
3. abutment/encasement of hepatic artery or short segment occulusion of SMV
32
what's the status of NACT or NACRT for pancreatic cancer in UK?
not used currently
33
How is LA pancreatic cancer treated?
High risk of micro metastatic disease, porgression occurs in 30 to 40 % of pts in fisrt 3 to 4 months,
so Chemotherapy is preferred over CRT.
34
chemotherapy regimens for LAPC? NCCN 2025
FOLFIRINOX or modified
FOLFIRINOX
* Gemcitabine + albuminbound paclitaxeld
* Liposomal irinotecan
+ 5-FU + leucovorin +
oxaliplatin (NALIRIFOX)
35
Acceptable Rx option for LAPC:
Induction chemo for 3 to 4 cycles followed by consolidation CRT (50.4 to 54 Gy/ 28/30#) with capecitabine @ 830 mg/m2 BD on Rx days
36
Regimens for metastatic pancreatic cancer?
FOLFIRINOX (category 1) or
modified FOLFIRINOX
* Gemcitabine + albumin-bound
paclitaxel (category 1)
* NALIRIFOX
37
S/Es of FOLFIRINOX?
Grade 3/4 toxicity including neutropenia 45.7%
fatigue 23%
diarrhoea 12.7%
neuropathy 9%
38
2nd L chemo for metastatic pancreatic cancer
OFF (oxaliplatin, folinic. acid and 5 FU)
CAPEOX
Gem Erlotinib
39
How is ITV generated ?
combining GTV outlines from multiple phases of respiration
atleast 3 phases, end inspiration, end expiration, and time weighted average or conventional 3D scan
40
What's RT dose is given for pancreatic cancer?
50 . 4 Gy/ 28#
41
what SBRT dose is given in pancreatic cancer
40 Gy/ 5#
42
NALIRIFOX
NAPOLI 3
(NALIRIFOX (liposomal irinotecan 50 mg/m2, oxaliplatin 60 mg/m2, leucovorin 400 mg/m2, and fluorouracil 2400 mg/m2, administered sequentially as a continuous intravenous infusion over 46 h) on days 1 and 15 of a 28-day cycle ) NAPOLI 3
43
How many new cases of pancreatic cancer are diagnosed annually in the UK?
Approximately 7400 new cases
## Footnote
In the USA, there are about 37,000 new cases each year.
44
What is the peak age group for pancreatic cancer incidence?
65–75 year age group
45
What percentage of pancreatic cancer patients are older than 65 years?
60%
46
What is the male to female ratio for pancreatic cancer?
1.25:1
47
What percentage of patients present with early-stage disease amenable to curative surgery?
10–15%
48
What percentage of pancreatic cancer patients survive more than 5 years?
4%
49
What are the suggested risk factors for pancreatic cancer? List at least three.
* Cigarette smoking
* Increasing age
* Chronic pancreatitis
## Footnote
Other factors include late-onset diabetes mellitus, hereditary pancreatitis, and cancer family syndromes.
50
By how much does cigarette smoking increase the risk of pancreatic cancer?
Twofold
51
What percentage of pancreatic cancer cases are attributed to cigarette smoking?
30%
52
What is the risk increase for chronic pancreatitis regarding pancreatic cancer?
15–25%
53
What genetic condition is associated with hereditary pancreatitis?
Mutation of PRSS1 gene
54
What is the magnitude of risk increase for hereditary pancreatitis?
70-fold
55
What percentage of pancreatic cancer cases are accounted for by cancer family syndromes?
10%
56
Name two cancer family syndromes associated with pancreatic cancer.
* Peutz–Jeghers syndrome
* Familial adenomatous polyposis
## Footnote
Other syndromes include familial atypical multiple mole melanoma and Li–Fraumeni syndrome.
57
What type of carcinoma develops through an adenoma–carcinoma sequence?
Ductal adenocarcinoma
58
What is the most common malignant tumor of the pancreas?
Ductal adenocarcinoma
59
What are the variants of ductal adenocarcinoma? List at least two.
* Undifferentiated (anaplastic)
* Adenosquamous
## Footnote
Other variants include signet ring cell carcinoma and mucinous non-cystic.
60
What percentage of pancreatic tumors are located in the head of the pancreas?
65%
61
What percentage of pancreatic tumors are located in the body?
15%
62
What percentage of pancreatic tumors are located in the tail?
10%
63
What percentage of pancreatic tumors are multifocal?
10%
64
What are the common clinical features of tumours of the head of the pancreas?
Obstructive jaundice, acute lymph node metastasis, poor clinical status and co-morbidities.
65
What factors determine the type of primary surgery for pancreatic tumours?
Location of the tumour.
66
What is the proven role of adjuvant treatment after R0 resection in pancreatic cancer?
There is no proven role.
67
What is the reported 5-year survival rate for patients undergoing neoadjuvant chemoradiotherapy followed by liver transplantation?
82%.
68
What is the primary management goal for unresectable pancreatic tumours?
Palliative and supportive care.
69
How is jaundice managed in patients with unresectable tumours?
With stent or biliary bypass.
70
List some evolving treatments for unresectable pancreatic tumours.
* Photodynamic therapy
* High intensity focused ultrasound (HIFU)
* Radiofrequency ablation
* Palliative radiotherapy
* Drug coated stents
71
What are the survival rates after surgical resection based on completeness?
* R0 resection: 20–40%
* R1 resection: 5–10%
* R2 resection: 0%
72
What imaging modalities are useful for assessing cystic tumours?
Magnetic resonance cholangio-pancreatography (MRCP).
73
What is the utility of endoluminal ultrasonography (EUS) in pancreatic cancer diagnosis?
Detecting small tumours and biopsy of small lesions.
74
What is the role of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosis?
Rarely used for diagnosis; mainly to insert biliary stent and obtain biopsy.
75
When is percutaneous transhepatic cholangiography (PTC) useful?
To relieve jaundice when ERCP has failed or is not possible.
76
How is tissue diagnosis typically obtained for pancreatic cancer?
By EUS with fine needle aspiration (FNA).
77
What are the sensitivity and specificity of EUS with FNA for tissue diagnosis?
Sensitivity: >90%; specificity: almost 100%.
78
What blood tests are commonly performed in suspected pancreatic cancer cases?
* FBC
* Biochemistry
* Clotting profile
* Serum CA19.9
79
What is the sensitivity of serum CA19.9 as a tumour marker?
70–90%.
80
What are some presenting features of tumours of the body and tail of the pancreas?
* Fatigue
* Back pain
* Weight loss
* Late onset diabetes mellitus
* Steatorrhoea
* Duodenal obstruction
81
What are the signs observed during a general examination of pancreatic cancer?
* Anaemia
* Jaundice
* Cachexia
* Enlarged left supraclavicular node (Troisier’s sign)
82
What are some abdominal examination findings in pancreatic cancer?
* Abdominal mass
* Ascites
* Hepatomegaly
* Umbilical nodule
83
What are the initial investigations for diagnosing pancreatic cancer?
* Abdominal ultrasound
* CT scan
84
What is the accuracy of CT scans in determining the resectability of a tumour?
80–90%.
85
What are the initial blood tests performed for pancreatic cancer?
FBC, biochemistry and clotting profile
## Footnote
FBC stands for Full Blood Count.
86
What is the commonly used tumour marker for pancreatic cancer?
Serum CA19.9
## Footnote
Sensitivity of CA19.9 ranges from 70–90%.
87
What are some presenting features of pancreatic cancer?
* Fatigue
* Back pain
* Weight loss
* Late onset diabetes mellitus
* Steatorrhoea
* Duodenal obstruction
88
What signs may be observed during a general examination of a patient with pancreatic cancer?
* Anaemia
* Jaundice
* Cachexia
* Enlarged left supraclavicular node (Troisier’s sign)
89
What findings might be observed during an abdominal examination for pancreatic cancer?
* Abdominal mass
* Ascites
* Hepatomegaly
* Umbilical nodule
90
What are the initial imaging studies for diagnosing pancreatic cancer?
* Abdominal ultrasound
* CT scan of the chest, abdomen and pelvis
91
What can abdominal ultrasound detect in pancreatic cancer?
* Biliary and pancreatic duct dilatations
* Tumours >2 cm
* Liver metastases
92
What is the accuracy of CT scans in determining the resectability of pancreatic tumours?
80–90%
## Footnote
CT scans help in local and distant staging.
93
What surgical options are considered curative for tumours of the head of the pancreas?
* Pancreaticoduodenectomy (classic Whipple)
* Pylorus preserving pancreatoduodenectomy (pp Whipple)
94
What is the postoperative morbidity and mortality rate for radical surgery in pancreatic cancer?
Morbidity ~40%, mortality <5%
95
What is the purpose of neoadjuvant therapy in pancreatic cancer?
To improve resectability in borderline resectable tumours
96
What combination of treatments is used in neoadjuvant therapy?
* External beam radiotherapy
* 5-FU or Gemcitabine based chemotherapy
97
What are the reported rates for resection and negative resection margins in neoadjuvant therapy?
* Resection rate: 60%
* Negative resection margin: 90%
98
What does adjuvant chemotherapy improve according to meta-analysis?
* 5 year survival (19% vs. 12%)
* Median survival (19 months vs. 13.5 months)
99
What is the significance of a CA19-9 level of <200 u/ml?
Suggests longer survival
100
What is the role of laparoscopy with laparoscopic ultrasound before surgery?
Alters management in 15% of patients already assessed as resectable by CT
101
How does selective laparoscopy improve patient management?
* Reduces proportion of patients undergoing laparoscopic ultrasound from 100% to ~45%
* Increases yield from 15% to 25%
102
What is the primary aim of surgery for patients with resectable pancreatic cancer?
Complete microscopic resection (R0)
## Footnote
R0 indicates no residual tumor after surgery.
103
What percentage of pancreatic cancer resections result in microscopic residual disease (R1)?
30–60%
## Footnote
R1 indicates that microscopic residual disease is present after surgery.
104
What are the criteria for resectable pancreatic cancer?
* No coeliac, hepatic or superior mesenteric artery involvement
* A patent superior mesenteric-portal venous confluence
* Portal venous involvement of not more than 2 cm in length or more than 50% circumference
* No liver, peritoneal or other distant metastases
* Absence of portal hypertension and cirrhosis
* No severe co-morbidity to exclude surgery
105
What is the median survival following surgical resection of pancreatic cancer?
11–20 months
## Footnote
Survival can vary based on several factors, including resectability and performance status.
106
What is the median survival for metastatic pancreatic cancer without active treatment?
3–6 months
## Footnote
This is significantly shorter compared to those with locally advanced disease.
107
What are the main types of pancreatic endocrine tumours?
* Insulinoma
* Gastrinoma
* Glucagonoma
* VIPoma
108
What is the mean age at presentation for pancreatic endocrine tumours?
47 years
109
What condition is associated with insulinomas?
Hypoglycaemia associated with fasting or vigorous exercise
## Footnote
Symptoms are rapidly relieved by eating a snack or drinking a liquid rich in glucose.
110
What defines a diagnosis of insulinoma?
Very low blood sugar (<2 mmol/l) and a high level of insulin and C-peptide
## Footnote
This indicates endogenous insulin production.
111
What was the outcome of the meta-analysis on adjuvant chemoradiotherapy for pancreatic cancer?
No improvement in survival compared with no treatment (median survival 15.8 months vs. 15.2 months)
## Footnote
This indicates that adjuvant chemoradiotherapy may not be effective.
112
What did the RTOG 9704 trial report regarding adjuvant chemo RT?
No statistically significant survival benefit with gemcitabine to adjuvant 5-FU based chemoradiotherapy
113
What is the 5-year survival rate for pancreatic cancer after radical resection?
Around 10%
## Footnote
This highlights the poor prognosis associated with pancreatic cancer.
114
What is the significance of performance status in the prognosis of pancreatic cancer?
It is one of the most important prognostic factors.
115
What is the classification of pancreatic cancer staging Stage IIB?
T1–3N1M0 (Regional lymph node metastasis)
116
What does Stage IV pancreatic cancer indicate?
Any T any N M1 (Distant metastasis)
117
What is the management for obstructive jaundice in pancreatic cancer?
Managed with biliary stent or surgical bypass
118
What type of stents are used for patients with metastatic disease and tumours of >3 cm diameter?
Plastic stents
119
What type of stents are used for patients with good performance status and locally advanced disease of <3 cm?
Self-expanding metal stents
120
What is the role of early studies combining gemcitabine with EGFR inhibitor erlotinib?
Showed some activity, but the exact role of EGFR inhibitors is still evolving
121
What percentage of patients will present with unresectable cancer?
70%
## Footnote
This indicates a significant portion of cancer patients face challenges with surgical options.
122
What type of treatment is primarily provided to patients with unresectable cancer?
Palliative treatment
## Footnote
This approach focuses on relieving symptoms rather than curing the disease.
123
List three treatment options for patients with unresectable cancer.
* Palliative chemotherapy
* Palliative chemoradiotherapy
* Symptom control
## Footnote
These options are aimed at improving quality of life.
124
What is the single agent response rate for palliative chemotherapy?
Seldom more than 10%
## Footnote
This indicates limited effectiveness of single-agent chemotherapy.
125
What does a meta-analysis suggest about chemotherapy compared to best supportive care?
Chemotherapy improves survival (HR 0.64; 95% CI, 0.42–0.98)
## Footnote
This highlights the benefit of chemotherapy in extending life.
126
What is the median survival time with single agent 5-FU?
5–6 months
## Footnote
This represents a baseline expectation for patients treated with this agent.
127
Which drug has a better median survival compared to 5-FU?
Gemcitabine
## Footnote
Gemcitabine shows a median survival of 5.7 months.
128
What is the 1-year survival rate for patients treated with gemcitabine compared to 5-FU?
18% vs. 2%
## Footnote
This stark difference underscores the effectiveness of gemcitabine.
129
What is the current drug of choice for unresectable cancer?
Gemcitabine
## Footnote
Its efficacy and lower toxicity make it preferable.
130
What does a recent meta-analysis indicate about gemcitabine combination chemotherapy?
It improves survival compared with gemcitabine alone (HR = 0.91; 95% CI, 0.85–0.97)
## Footnote
Combination therapies can enhance treatment outcomes.
131
Name two commonly used drugs in combination with gemcitabine.
* Capecitabine
* Platinum
## Footnote
These drugs are often paired to increase treatment effectiveness.
132
What is the role of palliative chemoradiotherapy with external beam radiotherapy and 5-FU or gemcitabine?
Not clear
## Footnote
Further research is needed to clarify its effectiveness.
133
What did a meta-analysis find about chemoradiotherapy compared to radiotherapy alone?
Chemoradiotherapy increases survival (HR 0.69, 95% CI 0.51–0.94)
## Footnote
This suggests a potential benefit of combining therapies.
134
Is there a survival difference between chemotherapy alone and chemoradiotherapy followed by chemotherapy?
No survival difference
## Footnote
Indicates that both approaches may yield similar outcomes.
135
What are the measures for pain control in symptom management?
Analgesics, celiac plexus block, unilateral thoracoscopic splanchnicectomy
## Footnote
These measures aim to alleviate pain in patients with advanced conditions.
136
How is obstructive jaundice managed?
Biliary stent, surgical bypass
## Footnote
Plastic stents are used for metastatic disease and tumors >3 cm; self-expanding metal stents for good performance status and locally advanced disease <3 cm.
137
What treatments are available for duodenal obstruction?
Endoscopically placed stents, bypass surgery
## Footnote
These interventions aim to relieve obstructions in the duodenum.
138
What early studies have shown activity in pancreatic cancer treatment?
Combination of gemcitabine with EGFR inhibitor erlotinib
## Footnote
The role of EGFR inhibitors in treatment is still evolving.
139
What are the most important prognostic factors in pancreatic cancer?
Resectability, performance status
## Footnote
These factors significantly influence survival outcomes in patients.
140
What is the median survival for patients following surgical resection of pancreatic cancer?
11–20 months
## Footnote
This varies based on individual patient circumstances.
141
What is the median survival without active treatment for metastatic pancreatic cancer?
3–6 months
## Footnote
Locally advanced disease has a median survival of 6–10 months.
142
What is the 5-year survival rate following radical resection of pancreatic cancer?
Around 10%
## Footnote
This indicates the challenges associated with treating pancreatic cancer.
143
What types of pancreatic endocrine tumours are there?
Insulinoma, gastrinoma, glucagonoma, VIPoma
## Footnote
These tumours arise from the islet cells of the pancreas.
144
At what mean age do pancreatic endocrine tumours typically present?
47 years
## Footnote
This age can vary based on genetic predispositions.
145
What genetic syndromes are associated with an increased risk of pancreatic endocrine tumours?
MEN1, Von Hippel–Lindau, neurofibromatosis type 1, tuberous sclerosis
## Footnote
These syndromes increase susceptibility to various types of tumours.
146
How do insulinomas clinically present?
Features of hypoglycaemia associated with fasting or vigorous exercise
## Footnote
Symptoms are rapidly relieved by eating or drinking glucose-rich liquids.
147
What is the diagnostic criteria for insulinomas?
Very low blood sugar (<2 mmol/l), high level of insulin and C-peptide
## Footnote
These indicators confirm the presence of endogenous insulin production.
148
What condition presents with refractory multiple peptic ulcers and diarrhoea?
Gastrinoma
## Footnote
Diagnosed by high gastrin levels (>100 pg/ml, or >200 pg/ml after secretin stimulation)
149
What are the characteristic features of glucagonoma?
Hyperglycaemia, stomatitis, weight loss, diarrhoea, psychiatric disturbances, necrolytic migratory erythema
## Footnote
Diagnosis is by high plasma glucagon levels
150
What does VIPoma cause?
Watery diarrhoea and hypokalaemia
## Footnote
Diagnosis is by high plasma levels of vasoactive intestinal polypeptide
151
What are the staging investigations for pancreatic endocrine tumours?
CT scan, MRI scan, EUS, 111In-octreotide, selective portal/splenic venous sampling, intraoperative ultrasound
## Footnote
Surgical resection is the treatment of choice even in metastatic disease
152
What is the 5-year survival rate following surgical resection of pancreatic endocrine tumours?
50–95%
## Footnote
This statistic varies based on the specific circumstances of the patient and the tumour
153
What percentage of pancreatic cystic masses are cystic tumours?
15%
## Footnote
Common types include serous cystic neoplasms, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms
154
What is the management approach for serous cystic neoplasms?
Conservative approach with regular imaging
## Footnote
These predominantly affect women and are found mostly in the head of the pancreas
155
What is the primary treatment for mucinous cystic neoplasms?
Resection
## Footnote
These affect the body and tail of the pancreas and represent 40% of primary cystic neoplasms
156
What should be done with IPMNs arising from the main duct?
Resected
## Footnote
IPMNs constitute 30% of pancreatic cysts and those from branch duct may be managed with regular follow-up imaging
157
What are carcinoid tumours?
Neuroendocrine neoplasms arising from enterochromaffin cells
## Footnote
These can be functioning or non-functioning, with a mean age at presentation of 49 years
158
Who is more commonly affected by carcinoid tumours?
Women
## Footnote
The mean age at presentation is 49 years
159
What is the clinical presentation of a carcinoid tumour?
Non-specific abdominal symptom; carcinoid syndrome can occur in 25% of cases.
## Footnote
Carcinoid syndrome may include flushing, diarrhea, and wheezing.
160
What is the diagnostic imaging of choice for carcinoid tumours?
CT scan.
## Footnote
CT scans provide detailed images that help in identifying the presence and extent of carcinoid tumours.
161
What is the treatment of choice for resectable carcinoid tumours?
Surgery.
## Footnote
Surgical resection can provide a potential cure if the tumour is localized.
162
What percentage of patients present with advanced disease in carcinoid tumours?
70–80%.
## Footnote
Advanced disease significantly impacts treatment options and prognosis.
163
What are the treatment options for advanced carcinoid disease?
Treatment options include:
* Symptom control using octreotide or a long acting version
* Radioisotope treatment using 131I-MIBG or 111In/90Y octreotide
* Palliative chemotherapy – streptozosin plus 5-FU/dacarbazine and doxorubicin plus 5-FU.
## Footnote
These treatments aim to manage symptoms and improve quality of life.
164
What is the overall five-year survival rate for patients with carcinoid tumours?
30–40%.
## Footnote
Survival rates can vary significantly based on disease stage and treatment options.
165
What is the median survival for patients with metastatic carcinoid disease?
Approximately 7 months.
## Footnote
Metastatic disease indicates a poorer prognosis compared to localized tumours.
