endocrine secretions of the pancreas 4

insulin glucagon somatostatin pancreatic polypeptide

exocrine secretion of the pancreas 3

pancreatic amylase proteases lipase

risk factors for pancreatic cancer 3

smoking high body mass, lack of physical activity diabetes mellitus

B5-100 Pancreatic Cancer Flashcards by Felicia Jones

exocrine cells of the pancreas

acinar cells

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endocrine cells of the pancreas

islet of langerhans

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endocrine secretions of the pancreas

insulin
glucagon
somatostatin
pancreatic polypeptide

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exocrine secretion of the pancreas

pancreatic amylase
proteases
lipase

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risk factors for pancreatic cancer

smoking
high body mass, lack of physical activity
diabetes mellitus

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most pancreatic cancer begins in the […] of the pancreas

head

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tumors in the head of pancreas more commonly present with

jaundice
steatorrhea
weight loss

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descibe pain characteristic of pancreatic cancer

insidious onset
gnawing, visceral epigastric pain
radiates to both sides of back
worse when lying down, after meal, at night
improves with sitting forward

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25% of pancreatic cancer is heralded by new onset

diabetes mellitus

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pruritis
dark urine
and pale stool are signs of

jaundice

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thromboembolic events occur more commonly with tumors in the […] of the pancreas

body/tail

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typical sites of metastasis of pancreatic cancer

liver
peritoneum
lungs

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jaundice from pancreatic cancer is caused by […] hyperbilirubinemia

conjugated

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most frequently mutated gene
presenting in >90% of cases

activating KRAS

D>V>C

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[…] inactivation occurs in 95% of pancreatic cancer

loss of checkpoint

p16/CDKN2A

tumor suppressors

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inactivation in 75-80% of pancreatic cancer
inactivation through LOH
loss of regulation of proliferation/apoptosis

p53

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inactivation in 50% of pancreatic cancer
inactivation through LOH
inhibition of TGFb and BMP signaling pathways

SMAD4

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used diagnostically to suggest pancreas as possible primary with mets of unknown site

gene

SMAD4

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most common cause of familial pancreatic cancer

BRCA2/1

PALB2 less frequent

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BRCA and PALB2 mutations are sensitive to what therapies?

PRAP inhibitor
mitomycin
platinum chemo drugs

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germline mutation of tumor suppressor
regulates cell polarity
PJS

STK I

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for a patient presenting with epigastric pain we should get […] to evaluate for pancreatitis

lab

serum lipase

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intital imaging for patients with jaundice
high sensitivity for biliary obstruction and pancreatic mass > 3cm

transabdominal ultrasound

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first test for patients with jaundice and a high suspicion of choledocholithiasis

ERCP or MRCP

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* most widely used and most sensitive imaging modality for evaluation of pancreatic cancer * can detect tumor <2cm

preferred intital imaging in patients without jaundice

used to guide biopsies when histological confirmation is needed

EUS

if the tumor involves the SMA, celiac axis, and/or common hepatic it is T[..] regardless of size | staging

N category of staging assesses

regional lymph node involvement * NX- cannot be assessed * N0- none * N1- 1 to 3 lymph nodes * N2- 4+ lymph nodes

M category of staging assesses

distant metastasis M0- none M1- distant metastasis

if tumor is M1, it is stage [...] regardless of T or N

treatment for metastatic disease | first and second line

first: folfirinox or gemcitabine second: folfox

treatment for non-metastatic resectable disease

resect gemcitabine

treatment for non-metastatic, non-resectable disease

folfirinox

what makes a patient a candidate for resection?

* limited to pancreas * limited nodal involvement * limited vascular involvement | only 15-20% are resectable

why do only 38% of patients with resectable disease receive surgery?

* low SES * physician pessimism regarding prognosis

most commonly used procedure for resectable pancreatic cancer

Whipple | pancreaticoduodenectomy

postoperative complications of resecting pancretic cancer | 3

* delayed gastric empyting * pancreatic fistulas * wound infections

is a standard or extended lymphadenectomy the preffered operation?

standard | extended shows no benefit and may have worse outcomes

if a pancreatic tumor in the body/tail is deemed resectable (rare), what procedure is performed?

distal subtotal pancreatectomy with combine splenectomy

mutations associated with pancreatic NETs | 2

PTEN MEN1

what functional PanNET causes hypoglycemia?

insulinoma

what functional PanNET causes Zollinger Ellison and steatorrhea? | ulcers in unsual places

gastrinoma

what functional PanNET causes watery diarrhea, hypokalemia, and achlohydria?

VIPoma

what functional PanNET causes diabetes mellitus and necrolytic migratory erythema?

glucagonoma

what functional PanNET causes DM, steatorrhea, and hypochlorhydria?

somatostatinoma

VIPoma is due to a tumor in what cell type?

treatment for most functional PanNETs

somatostatin analogs (octreotide)

which type of pancreatic adenocarcinoma precusor lesion is able to be radiographically detected?

cystic lesions

PanIN-1A mutations

ERBB2 **KRAS**

PanIN-2 mutation

CDKN2A

PanIN-3 mutations

tp53 SMAD4 BRCA2

tumer diameter <2cm | T_

maximum tumor diameter greater than 2 cm less than 4 cm | T_

maximum tumor diameter >4 cm | T_

* fatigue * shakiness * hunger * irritability | symptoms of

insulinoma

* gastric ulcers * abdominal pain * nausea * vomiting * elevated serum gastrin

gastrinoma

* thirst * frequent urination * abdominal pain | symptoms of

glucagonoma | hyperglycemia

imaging modality used to monitor functional NETs

dotatate PET/CT

* amylase: low * CEA: low * CA72-4: low * CA 19-9: variable * CA 125: low

serous cystadenoma

* amylase: low * CEA: high * CA72-4: high * CA 19-9: variable * CA 125: variable

mucinous cystic neoplasm

* amylase: high * CEA: high * CA72-4: high * CA 19-9: variable * CA 125: low

IPMN

* amylase: high * CEA: low * CA72-4: low * CA 19-9: high * CA 125: low

pseudocyst

most common type of pancreatic cancer?

ductal adenocarcinoma

most common symptoms in pancreatic cancer | 3

jaundice weight loss epigastric pain

what gene mutation may have a better response to checkpoint inhibitor treatment?

MLH1/MSH2/6 | defects in DNA mistmatch repair respond better

what organs are involved in a whipple? | 5

* distal stomach * duodenum * head of pancreas * common bile duct * gallbladder

an immune checkpoint inhibitor can be used in what mutations?

DNA mistmatch repair | MLH/MSH

biomarker for pancreatic cancer

CA 19-9

new onset diabetes is an independent risk factor for

pancreatic cancer

hemolysis causes elevation of [...] bilirubin

unconjugated

* ducts lined by a single layer of epithelial cells * significant collagen within the walls of some ducts * well organized ductal structure

normal pancreas

cells with large nuclear/cytoplasm ratio and marked nuclear polymorphism

pancreatic ductal adenocarcinoma

"drunken honeycomb"

pancreatic ductal adenocarcinoma

pancreatic ductal adenocarcinoma | left: normal honeycomb, right: drunken honeycomb

recommendation for treatment with low ECOG and favorable cormobidities

chemotherapy

metastasis is a [...] to surgery

contraindication

when there is mismatch repair deficiency or microsatellite instability, what treatment can be used?

checkpoint inhibitors (PD1)

treatment for known HRR deficiency

PARP inhibitors

more than 180 involvement of SMV or portal vein but lacks contact with other vasculatures

borderline resectable

what is removed during a Whipple?

* distal stomach * duodenum * head of pancreas * gallbladder * part of common bile duct

tumor is in contact with aorta

unresectable

what is the advantages of PPPD?

* reduced blood loss during surgery * shorter operating time

are most PNNs functional or nonfunctional?

nonfunctional 70%

a tumor in the head of the pancreas is in close proximity to what parts of the duodenum? | 3

superior descending horizontal

what part of the duodenum is near the body and tail of the pancreas?

ascending

why is the stomach less likely to be invaded by pancreatic cancer?

it is intraperitoneal and can move

two arteries that supply the head of the pancreas

gastroduodenal superior mesenteric

supplies body and tail of pancreas

splenic artery

normally expressed in fetal tissues and typically low in adults but some pancreatic neoplasms express

CEA

whipple triad

symptoms of hypoglycemia low plasma glucose relief of symptoms with glucose administration | insulinoma

* peptic/duodenal ulcers * gastroesophageal reflux * diarrhea

gastrinoma

4 Ds of glucagonoma

* diabetes * dermatitis (necrolytic migratory erythema) * deep vein thrombosis * depression

verner-morrison syndrome

* watery diarrhea * hypokalemia * achlorhydria/hypochlorhydria | glucagonoma

* DM * diarrhea * steatorrhea * anemia * malabsorption * cholelithiasis

somatostatinoma

what 2 NETs are closely associated with MEN1 mutations?

gastrinoma insulinomas

B5-100 Pancreatic Cancer Flashcards

(96 cards)