𝑷𝒂𝒏𝒄𝒓𝒆𝒂𝒕𝒊𝒄 𝑪𝒂𝒏𝒄𝒆𝒓

Question 1

What is the anatomical position of the pancreas?

Answer 1

A retroperitoneal organ anterior to the 1st lumbar vertebrae

Question 2

What are the typical dimensions of the pancreas?

Answer 2

Measures between 10-20cm long & weighs 75-125gm

Question 3

What are the four anatomical parts of the pancreas?

Answer 3

Head neck body & tail

Question 4

What is the anatomical position of the pancreatic head?

Answer 4

To the right of the midline within the C-loop of the duodenum anterior to the vena cava

Question 5

What arteries supply the pancreas?

Answer 5

Splenic artery (neck body & tail), superior & inferior pancreaticoduodenal arteries

Question 6

What are the main veins draining the pancreas?

Answer 6

Superior pancreaticoduodenal vein, superior mesenteric vein

Question 7

Where do the lymphatics of the body and tail of the pancreas drain?

Answer 7

Into the splenic hilar glands

Question 8

What are the two main functional categories of the pancreas?

Answer 8

Exocrine and endocrine functions

Question 9

What are the three main digestive enzymes produced by the pancreas?

Answer 9

Lipase peptidases and amylase

Question 10

What are the three main hormones produced by the pancreas?

Answer 10

Insulin glucagon and somatostatin

Question 11

What is the second most common pancreatic cancer?

Answer 11

Cystic neoplasm of the pancreas

Question 12

What is the most common cystic neoplasm of the pancreas?

Answer 12

Mucinous cystic neoplasm

Question 13

What is characteristic about mucinous cystic neoplasm demographics?

Answer 13

Frequently seen in young women and rarely affects men

Question 14

What hormonal staining is characteristic of mucinous cystic neoplasm?

Answer 14

Staining for estrogen & progesterone

Question 15

What is the typical presentation of serous cystic neoplasm?

Answer 15

Usually affects head of pancreas causing vague abdominal pain & less jaundice

Question 16

What is the most common type of pancreatic cancer?

Answer 16

Adenocarcinoma

Question 17

What is the 5-year survival rate for pancreatic adenocarcinoma?

Answer 17

<5% in 5 years

Question 18

What is the male to female ratio in pancreatic adenocarcinoma?

Answer 18

M:F is 13:1

Question 19

What is the peak age incidence for pancreatic adenocarcinoma?

Answer 19

65-75 years

Question 20

List five risk factors for pancreatic adenocarcinoma

Answer 20

Smoking obesity diabetes chronic pancreatitis hereditary factors

Question 21

What tumor suppressor genes are involved in pancreatic cancer?

Answer 21

PDX1 KRAS2 CDKN2A/p16 p53 DPCA

Question 22

What is the first constant symptom of pancreatic cancer?

Answer 22

Anorexia & weight loss

Question 23

What is Courvoisier’s law?

Answer 23

In a patient with jaundice if the gall bladder is palpable it is not due to gallstone

Question 24

Name 2 psychiatric manifestations of pancreatic cancer

Answer 24

Depression & Paranoia

Question 25

What imaging is preferred over CT in pancreatic cancer?

Answer 25

MRI is preferred over CT in pancreatic cancer

Question 26

What does ERCP stand for and what is its use?

Answer 26

Endoscopic Retrograde Cholangiopancreatography - evaluation of jaundiced patient for biopsy & stent

Question 27

What tumor markers are used in pancreatic cancer?

Answer 27

CA 19-9 , CEA & Pancreatic Oncofetal Antigen

Question 28

What is the pre-op fluid expansion requirement?

Answer 28

3-5L of crystalloids in 24 hrs

Question 29

What are the main surgical options for pancreatic cancer?

Answer 29

♦️ Open ♦️ Laparoscopic/robotic assisted (Whipple operation or pancreatico-duodenectomy)

Question 30

State 2 indications for Whipple Operation/Pancreatico-duodenectomy

Answer 30

♦️Pancreatic head Lesion ♦️Pylorus preserving pancreatico-duodenectomy

Question 31

List five complications of pancreatic resection

Answer 31

Hemorrhage Renal failure Pancreatic fistula Intra-abdominal abscess Delayed gastric emptying

Question 32

What chemotherapy agents are used in pancreatic cancer?

Answer 32

Gemcitabine/capecitabine and 5FU with radiotherapy

Question 33

When is radiotherapy indicated in pancreatic cancer?

Answer 33

For intractable pain

Question 34

What does EUS stand for and what is its role?

Answer 34

Endoscopic Ultrasound - used for imaging and staging

Question 35

What is the significance of Sister Mary Joseph node?

Answer 35

It's a sign of metastatic spread typically found at the umbilicus

Question 36

What metabolic complications can occur in pancreatic cancer?

Answer 36

hyperglycemia

Question 37

How is hypoprothrombanemia corrected?

Answer 37

By administration of vitamin K

Question 38

What is the purpose of cholecystjejunal anastomosis?

Answer 38

Relieves jaundice & pruritus

Question 39

What imaging helps determine the level of blockage?

Answer 39

Contrast enhanced multi-sliced CT

Question 40

What is the purpose of barium studies?

Answer 40

Shows pancreatic augmentation & narrowing of 1st-3rd parts of the duodenum

Question 41

In what condition is palliative surgery considered?

Answer 41

If the tumour is obstructive

Question 42

Name three types of palliative procedures

Answer 42

Endoprosthesis Chole-cystjejunal anastomosis Entero-enteroanastomosis

Question 43

Where do pancreaticoduodenal lymph nodes drain?

Answer 43

Into the superior mesenteric vein

Question 44

Clinical features of Pancreatic Ca

Answer 44

“COURAGE”: C – Cachexia (weight loss) O – Obstructive jaundice U – Upper abdominal pain (radiating to the back) R – Recent-onset diabetes (hyperglycemia) A – Anorexia, Abdominal tenderness, Ascites G – GI symptoms (nausea, vomiting, steatorrhea) E – Enlarged gallbladder (Courvoisier’s law) & Liver

Question 45

State 5 investigations of Pancreatic Ca

Answer 45

♦️Abdominal USS ♦️ ERCP (Endoscopic retrograde cholangio-pancreatography) ♦️ CT ♦️ MRI (preferred over CT) ♦️ Barium Studies (shows reverse 3 sign) ♦️ LFT (in jaundiced patients) ♦️ Tumour markers (CA 19-9, CEA, pancreatic oncofetal antigen)

Question 46

What are the pre-op preparations for pancreatic ca?

Answer 46

♦️Rehydration ♦️Hyperalimentation (provision of excessive nutrients through artificial means) ♦️Correction of anemia ♦️Hypoprothrombinaemia correction by administration of vitamin K ♦️Prophylactic broad spectrum antibiotics