pancreatic cancer Flashcards

1
Q

median age of diagnosis

A

70

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2
Q

who gets it more male or female

A

male

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3
Q

what are the majority of cancers

A

adenocarcinoma

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4
Q

whee are majority origin

A

ductal origin

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5
Q

what increases incidence

A
  • smoking
  • alcohol
  • coffee
  • aspirin use
  • diabetes
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6
Q

what mutation in chronic pancreatitis increases risk

A

PRSS-1

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7
Q

what type of gene is BRCA2

A

DNA repair gene

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8
Q

where does the cancer originate

A

in the ductal epithelium

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9
Q

what are the precursors of malignancy

A

pancreatic intraepithelial neoplasia (PainIN)

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10
Q

what mutation does majority of patients have

A

KRAS

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11
Q

if there is a mutation in tumour suppressors (p53, SMAD) what type of neoplasia does it cause

A

type 2
and
type 3 lesions

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12
Q

what is the genetic model for development of pancreatic malignancy

A
  1. normal
  2. PanIN-1A
  3. PanIN-1B
  4. PanIN-2
  5. PanIN-3
  6. invasion
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13
Q

where do a small percentage of pancreatic adenocarcinomas arise from

A

cystic lesions

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14
Q

where are most pancreatic cancers located

A

in head of pancreas

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15
Q

symptoms

A
  • abdominal pain radiates through to back
  • anorexia
  • weight loss
  • depressive
  • jaundice (early)
  • pale stools
  • dark urine
  • itching
  • malabsorption
  • steatorrhoea
  • skin nodules
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16
Q

what does malabsorption mean

A

the pancreatic duct is obstructed by cancer

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17
Q

signs

A
  • palpable gallbladder
  • palpable epigastric mass
  • hepatomegaly (if liver metastases)
18
Q

investigations if patients has upper gut symptoms

A

upper GI endoscopy

19
Q

what is the initial imaging investigation

A

ultrasound

20
Q

what is seen on ultrasound of bile obstruction

A

dilated intrahepatic bile ducts
and
mass in the head of the pancreas

21
Q

what investigation can confirm the presence of a mass lesion

A

CT

22
Q

what is the most sensitive for detection of pancreatic cancer

A

endoscopic ultrasound

23
Q

what tumour markers are good

A

CA19-9

24
Q

what is the only treatment for long term survival

A

surgical intervention

25
Q

what surgery is required to remove tumours of head and neck of pancreas

A

Whipple procedure

26
Q

how are tumours of the body and tail resected

A

distal pancreatectomy

27
Q

how to treat the pain

A

opiates

28
Q

treatment for nutritional deficit

A
  • early dietetic support

- pancreatic enzyme supplement

29
Q

what does jaundice usually occur with

A

anorexia and nausea and pruritus

30
Q

how to treat jaundice

A

endoscopic placement of endoprostheses (stent)

31
Q

what are most lesions

A

pseudocysts

32
Q

what imaging is used for characterising lesions

A

CT and MRI

33
Q

are lesions at risk of becoming malignant

A

yes

34
Q

where do pancreatic neuroendocrine tumours (NETs) arise from

A

islets of Langerhans

35
Q

what do NETs synthesise

A

insulin and glucagon

36
Q

what are majority of endocrine neoplasia

A

malignant

37
Q

symptoms of VIPoma

A
  • water diarrhoea
  • hypokalaemia
  • metabolic acidosis
38
Q

what are glucagonomas

A

alpha-cell tumours

39
Q

how are glucagonomas diagnosed

A

measuring pancreatic glucagon in the serum

40
Q

what are somatostatinomas

A

rare malignant D-cell tumours of the pancreas

41
Q

how are somatostatinomas diagnosed

A

high serum somatostatin levels

42
Q

examples of somatostain analogues

A

ocreotide and lanreotide