Biliary and Pancreatic Cancer

Question 1

Biggest risk factor for developing gallbladder cancer.

Answer 1

Gallstone disease (80% of GB cancer patients have gallstones)

Question 2

Which microbe adds risk to GB cancer?

Answer 2

Salmonella typhi

Question 3

Most common malignant tumors found in GB.

Answer 3

Adenocarcinoma

Question 4

What is a Krukenberg tumor?

Answer 4

A gallbladder adenocarcinoma that spreads into the peritoneum.

Question 5

Main tumor marker that is elevated in GB cancer.

Answer 5

CA19-9

Question 6

2 things often elevated in the serum with GB cancer.

Answer 6

1. ALP

2. Bilirubin

Question 7

Treatment for gallbladder cancer.

Answer 7

Tx: cholecystectomy, right hepatic lobectomy, or trisegmentectomy (removal of the true right lobe of the liver + most or all of the medial segment of the left lobe)

Question 8

Microbe responsible for most bile duct cancers esp. in southeast Asia.

Answer 8

Liver Flukes

Question 9

2 conditions associated with bile duct cancer.

Answer 9

1. Primary Sclerosing cholangitis
2. Ulcerative Colitis

(UC is not directly related but usually UC patients are checked for PSC which IS directly related)

Question 10

How does a Klatskin Tumor present?

Answer 10

Painless jaundice

-it’s a cholangiocarcinoma at the junction of the left and right hepatic ducts

Question 11

What serum bilirubin levels indicate bile duct cancer until it’s ruled out?

Answer 11

> 12 mg/dL

if painless jaundice occurs and levels are <8mg/dL then it is most likely a stone disease

Question 12

Treatment for Intrahepatic or Klatskin tumor.

Answer 12

Resection, hepatojejunostomy

Question 13

Treatment for mid-bile duct tumor

Answer 13

• resection
• cholecystectomy
• regional lymphadenectomy
• hepatojejunostomy

Question 14

Treatment for distal bile duct tumor

Answer 14

Whipple Procedure

Question 15

Most common site and presentation of Ductal Adenocarcinoma of the pancreas.

Answer 15

Head of the pancreas

-presents as jaundice due to pancreatic duct and bile duct obstruction

Question 16

What is the Courvoisier Sign?

Answer 16

Palpable gallbladder in ductal pancreatic cancer involving the head of the pancreas.

Question 17

What is a difference when using CT for diagnosis between adenomas and adenocarcinomas in the pancreas.

Answer 17

Benign adenomas calcify but malignant adenocarcinomas do not.

Question 18

Tumor marker that rises in the serum and can indicate pancreatic cancer.

Answer 18

CA19-9

Question 19

What is the double duct sign?

Answer 19

Both pancreatic and bile ducts are dilated. Viewed with ERCP and may indicate pancreatic cancer.

Question 20

Best method to stage pancreatic cancer.

Answer 20

Ultrasound

Question 21

Most effective treatment of pancreatic cancer.

Answer 21

Whipple Procedure or pancreatectomy

Question 22

Most common pancreatic endocrine neoplasm.

Answer 22

Insulinoma

Question 23

Dx of Insulinoma

Answer 23

Hypoglycemia + elevated insulin levels + pancreatic mass

insulin/glucose > 0.3

Question 24

What is Verner-Morrison syndrome?

Answer 24

Fasting large-volume diarrhea, hypokalemia, hypochlorohydria due to VIPoma of the pancreas.

Question 25

Major condition associated with Glucagonomas and Dx.

Answer 25

Necrolytic Migrating Erythema (dermatitis)

Dx: serum glucagon > 1000pg/ml + pancreatic mass

Question 26

Triad seen in a somatostatinoma.

Answer 26

Gallstones
Diabetes Mellitus
Diarrhea (steatorrhea due to inhibition of gallbladder contraction)

Question 27

Main complication of GRFoma.

Answer 27

Acromegaly

Question 28

Other tumor associated with GRFomas.

Answer 28

Gastrinoma (ZE syndrome)

Question 29

Tx for endocrine tumors.

Answer 29

Somatostatin (for all but somatostatinomas)

Surgical resection

Question 30

Treatment for ampullary carcinoma.

Answer 30

Whipple Procedure