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Surgical Recall > Chapter 54: Pancreas- Pancreatic Carcinoma > Flashcards

Chapter 54: Pancreas- Pancreatic Carcinoma Flashcards

1
Q

What is it?

A

Adenocarcinoma of the pancreas arising from duct cells

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2
Q

What are the associated risk factors?

A
  • Smoking 3× risk
  • diabetes mellitus
  • heavy alcohol use
  • chronic pancreatitis
  • diet high in fried meats
  • previous gastrectomy
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3
Q

What is the average age?

A

>60 years

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4
Q

What are the different types?

A
  • >80% are duct cell adenocarcinomas
  • other types include
    • cystadenocarcinoma
    • acinar cell carcinoma
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5
Q

What percentage arise in the pancreatic head?

A
  • 66% arise in the pancreatic head
  • 33% arise in the body and tail
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6
Q

Why are most pancreatic cancers in the tail nonresectable?

A
  • These tumors grow without symptoms until it is too late and they have already spread
  • head of the pancreas tumors draw attention earlier because of biliary obstruction
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7
Q

signs/symptoms of tumors based on location:
Head of the pancreas?

A
  • Painless jaundice from obstruction of common bile duct
  • weight loss
  • abdominal pain
  • back pain
  • weakness
  • pruritus from bile salts in skin
  • anorexia
  • Courvoisier’s sign
  • acholic stools
  • dark urine
  • diabetes
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8
Q

What are the signs/symptoms of tumors based on location:

Body or tail?

A
  • Weight loss and pain (90%)
  • migratory thrombophlebitis (10%)
  • jaundice (<10%)
  • nausea and vomiting
  • fatigue
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9
Q

What are the most common symptoms of cancer of the pancreatic
HEAD?

A
  1. Weight loss (90%)
  2. Pain (75%)
  3. Jaundice (70%)
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10
Q

What is “Courvoisier’s sign”?

A

Palpable, nontender, distended gallbladder

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11
Q

What is the classic presentation of pancreatic cancer in the head of
the pancreas?

A

Painless jaundice

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12
Q

What are the associated lab findings?

A
  1. Increased direct bilirubin and alkaline phosphatase (as a result of biliary obstruction)
  2. Increased LFTs
  3. Elevated pancreatic tumor markers
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13
Q

Which tumor markers are associated with pancreatic cancer?

A

Carbohydrate Antigen 19–9 ie CA-19–9

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14
Q

What diagnostic studies are performed?

A
  • Abdominal CT scan
  • U/S
  • cholangiography (ERCP to rule out choledocholithiasis and cell brushings)
  • endoscopic U/S with biopsy
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15
Q

What is the treatment based on location:

Head of the pancreas?

A

Whipple procedure (pancreaticoduodenectomy)

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16
Q

What is the treatment based on location:

Body or tail?

A

Distal resection

17
Q

What factors signify inoperability?

A
  • Vascular encasement (SMA, hepatic artery)
  • Liver metastasis
  • Peritoneal implants
  • Distant lymph node metastasis (periaortic/celiac nodes)
  • Distant metastasis
  • Malignant ascites
18
Q

Is portal vein or SMV involvement an absolute contraindication for
resection?

A

No—can be resected and reconstructed with vein interposition graft at some centers

19
Q

Define the Whipple procedure (pancreaticoduodenectomy)

A
  • Cholecystectomy
  • Truncal vagotomy
  • Antrectomy
  • Pancreaticoduodenectomy—removal of head of pancreas and duodenum
  • Choledochojejunostomy—anastomosis of common bile duct to jejunum
  • Pancreaticojejunostomy—anastomosis of distal pancreas remnant to jejunum
  • Gastrojejunostomy—anastomosis of stomach to jejunum
20
Q

What mortality rate is associated with a Whipple procedure?

A

<5% at busy high volume centers

21
Q

What is the “pylorus-preserving Whipple”?

A

No antrectomy; anastomose duodenum to jejunum

22
Q

What are the possible post-Whipple complications?

A
  • Delayed gastric emptying (if antrectomy is performed)
  • anastomotic leak (from the bile duct or pancreatic anastomosis)
  • causing pancreatic/biliary fistula
  • wound infection
  • postgastrectomy syndromes
  • sepsis
  • pancreatitis
23
Q

What is the postoperative adjuvant therapy?

A

Chemotherapy ± XRT

24
Q

What is the palliative treatment if the tumor is inoperable and biliary
obstruction is present?

A

Percutaneous transhepatic cholangiography (PTC) or ERCP and placement of stent across obstruction

25
Q

What is the prognosis at 1 year after diagnosis?

A

Dismal; 90% of patients die within 1 year of diagnosis

26
Q

What is the survival rate at 5 years after resection?

A

20%

Surgical Recall (168 decks)

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