75. Pancreatic adenocarcinoma Flashcards Preview

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Flashcards in 75. Pancreatic adenocarcinoma Deck (18)

origin / histology

arising form pancreatic ducts
histology: disorganized glandular structure with cellular infiltration


prognosis ( why)

average survival 1 year after diagnosis --> very aggressive , often metastatic at presentation


risk factors

1. TObacco
2. chronic pancreatitis ( esp >20 years
3. Diabetes
4. >50 age
5. Jewish and African american males


clinical presentation

1. abdominal pain radiating to back
2. weight loss ( malabsoroption and anorexia )
3. migratory thromboplenitis ( trousseau syndrome)
4. obstructive jaundice ( and pale stool) with Courvoisier sign ( if at head)
5. secondary DM ( if at body or tail)


Trousseau syndrmoe ? ( and frequency )

Migratory thrombophlebitis --> redness and tenderness on palpation of extremities ( seen in 10%)


courvoisier sign

presence of a palpably enlarged gallbladder which is nontender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones



1. Whipple procedure ( en bloc removal of the head and neck of pancreas, proximal duodenum, gallabladder)
2. chemotherapy
3. radiation therapy



1. CA 19-9
2. CEA ( not specific)


CEA as a marker

not specific
1. colocrecta ca (70%)
2. pancreatic ca (70%)
3. gastric ca
4. breast ca
5. medullary thyroid ca


• You diagnose a woman with pancreatic adenocarcinoma and she immediately asks about the prognosis. How do you respond?

The prognosis is poor—average survival is ~1 year after diagnosis, as it has typically already metastasized at the time of diagnosis


• A patient presents with weight loss, night sweats, and painless jaundice. Where is the tumor most likely located?

The pancreatic head (jaundice with a nontender, palpable gallbladder is the Courvoisier sign, associated with pancreatic adenocarcinoma)


• A mass is found on the head of the pancreas of a patient. What abnormal lab findings would be expected?

Increased alkaline phosphatase and bilirubin levels, indicating obstructive jaundice


• Obstructive jaundice with a palpable, nontender gallbladder on abdominal exam is known as what?

Courvoisier sign (associated with pancreatic adenocarcinoma, but also possibly due to other acute distal bile duct obstructions)


• You find redness and tenderness on palpation of the extremities in a patient with pancreatic adenocarcinoma. What is this sign called?

Trousseau syndrome, or migratory thrombophlebitis


• What two ethnic groups have an increased risk for pancreatic cancer?

Jewish and African-American male groups


• Which two tumor markers are commonly associated with pancreatic cancer? Which is more specific for the disease?

CA 19-9 (more specific) and carcinoembryonic antigen (CEA is less specific)


• Which is most likely to be a risk factor for pancreatic cancer: alcohol, cigarettes, or sulfa drugs?



• What causes the weight loss associated with pancreatic adenocarcinoma?

Malabsorption and anorexia due to the disorganized glandular structure of the pancreas

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