Pancreatic Carcinoma

Question 1

pancreatic carcinoma usually refers to….

Answer 1

ductal adenocarcinoma or a subtype (90% of pancreatic malignancies)

Question 2

risk factors for ductal adenocarcinoma

Answer 2

chronic pancreatitis, cigarettes, inheried pancreatitis

Question 3

survival in pancreatic carcinoma

Answer 3

really bad - 6% @ 5 yrs

• b/c dx at late stage

Question 4

PanIN

Answer 4

carcinoma in-situ: premalignant change in ductal epithelium. usually involve ducts <5mm in diameter

Question 5

benign pancreatic neoplasms

Answer 5

• most common = serous cystadenoma
• intraductal papillary-mucinous neoplasm
• mucinous cystic neoplasm
• pancreatitis can cause masses and cysts that are indistinguishable from neoplasm by imaging

Question 6

pancreatic cancer in 4 yo

Answer 6

pancreatoblastoma

sx: palpable mass, jaundice

better survival than other types of pancreatic cancer, usually found b/f metastatic

Question 7

pancreatic cancer in 20 yo female

Answer 7

solid-pseudopapillary neoplasm

low grade malignancy, resection usually cures

Question 8

cystic mass in pancreatic tail in 50 yo female

Answer 8

mucinous cystic neoplasm. 10-20% malignant

Question 9

epi for ductal adenocarcinoma

Answer 9

uncommon under age 50

Question 10

what is “resectable” PDAC?

Answer 10

only 15% of stage I and II PDAC

Question 11

problems w/ surgery for PDAC

Answer 11

1. incomplete resection… tumor left behind
2. early distant metastatic recurrence
3. complications delay adjuvant therapy

Question 12

what to do for borderline resectable PDAC?

Answer 12

neoadjuvant therapy - try to make the tumor smaller so we can resect it

• response is variable - look towards individualized therapy in the future

Question 13

definition of borderline resectable group

Answer 13

involvement of SMV and <180 degrees on SMA is maybe resectable; >180 degrees is not