hepatobilliary

Question 1

Unresectable criteria for ca pancreas

Answer 1

unresectable
• if the contact of the solid tumor with the SMA, celiac axis >180
• if the solid tumor is in contact with first jejunal branch of the SMA
• if there is SMV or PV in nonreconstructive condition
• if there is contact with the jejunal branch closest to the SMV

Question 2

Risk factor for pancreatic cancer

Answer 2

Acquired
- tobacco smoking
Diabetes mellitus
High body mass index
Chronic pancreatitis
Inherited disorder
- hereditory pancreatitis
FAMMM syndrome
HNPCC
Peutz jeghers syndrome
Li fraumeni syndrome

Question 3

Histologic classification of pancreatic cancer

Answer 3

Malignant:
Ductal adenocarcinoma
Mucinous cysta adenocarcinoma
Acinal carcinoma
Unclassified large cell carcinoma
Small cell carcinoma
Pancreatoblastoma
Benign:
Serous cystadenoma
Variable:
Mucinous cystadenoma

Question 4

Genetic testing for pancreatic cancer

Answer 4

Genetic counseling is recommended for patients who test positive for a pathogenic mutation (ATM, BRCA1, BRCA2, CDKN2A, MLH1, MSH2, MSH6, PALB2, PMS2, STK11, and TP53) or for patients with a positive family history of cancer, especially pancreatic cancer, regardless of mutation status

Question 5

preferred systemic chemotherapy for hepatocellular carcinoma

Answer 5

1st line:
atezolizumab+ bevacizumab
other: sorafenib, lenvatinib, durvalumab, nivolumab
2nd line:
regorafenib
cabozantinib
lenvatinib etc
if child pugh B: atezolizumab+ bevacizumab
or nivolumab preferred

Question 6

hepatic SBRT dose

Answer 6

30-50 gy in 3-5 fraction

Question 7

preferred systemic therapy for biliary tract cancer

Answer 7

adjuvant therapy:
preferred: capecitabine: 1250 mg/m2 D1-14
other:
folfox
capecitabine+ oxaliplatin
gemcitabine+ capecitabine(1000 mg D1,8+ 650mg/m2 D1-14)
gemcitabine+ cisplatin
single agent
5 fluorouracil , gemcitabine

Question 8

preferred chemotherapy regimen for pancreatic cancer:

Answer 8

limited evidence for neo adjuvant: folfirinox
gemcitabine+ nab pacli +- subsequent CT-RT
adjuvant:
preferred: mFOLFIRINOX
gemcitabine+ capecitabine
other:
bolus 5 fu+ leucovorin
gemcitabine

Question 9

preferred chemotherapy for pancreas locally advance cases

Answer 9

for good ps:
folfirinox or mfolfirinox
gem+ nab pacli
other:
gem+capecit
gem+ erlotinib
capox
Gem+ nab pacli+ cpl

Question 10

pancreas survival rate: median survival in months stage wise

Answer 10

IA- 36
IB- 36
IIA-36
IIB-18-24
III-18-24
III T4: 14-18 months
IV-9-12 months