EXAM #3: PANCREATIC CANCER Flashcards Preview

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Flashcards in EXAM #3: PANCREATIC CANCER Deck (48):
1

Where is pancreatic cancer more prevalent geographically?

In well developed countries

2

What is the mortality associated with pancreatic cancer in the US?

4th leading cause of cancer mortality in the US

*Note that is also has the poorest prognosis of all cancers

3

Where is the pancreas located?

Retroperitoneal in close proximity to the duodenum

4

What are the two types of cells in the exocrine pancreas?

Acinar cells and duct cells

5

What is the most common type of pancreatic cancer?

Adenocarcinoma arising from the exocrine pancreas (90%)

6

How would you describe the histopathology of an adenocarcinoma?

- Well differentiated cuboidal cells
- Duct-like structures that contain mucin

7

What oncogene is highly associated with pancreatic carcinoma?

K-ras (90%)

8

What diseases are associated with pancreatic adenocarcinoma?

- FAP
- Peutz-Jeghers
- Von Hippel-Lindau
- MEN1
- HNPCC
- BRCA
- Familial atypical multiple mole melanoma (FAMMM)

9

What are the non-genetic risk factors for pancreatic cancer?

- Age older than 45
- Chronic pancreatitis
- Smoking
- DM
- Diet high in fat/meat

10

What chemical exposures are risk factors for pancreatic cancer?

B-naphthylamine
Benzidine

11

What surgical history is a risk factor for pancreatic cancer?

Partial gastrectomy

12

How does pancreatic cancer typically present?

1) Abdominal pain
2) Weight loss
3) Jaundice
4) Steatorrhea
5) Pruritus

*Elderly patient that develops glucose intolerance*

13

How is pancreatic cancer diagnosed?

1) Spiral CT with IV contrast
- Determines mets and resectability
2) Confirm with biopsy

14

What are the determinants of resectablilty in pancreatic cancer?

1) No extrapancreatic disease
2) No direct tumor extension into the celiac axis and SMA

15

What is the utility of ERCP in pancreatic cancer?

1) Detection of small tumors not seen on CT
2) Palliation of biliary obstruction

16

What sign on imaging is pathognomonic for pancreatic adenocarcinoma?

"Double-duct" sign

17

What is EUS?

Endoscopic US

18

What is the utility of EUS in pancreatic cancer?

1) Aid in diagnosis and characterization of lesion
2) Biopsy

*EUS biopsy is associated with LESS peritoneal seeding compared to percutaneous CT guided biopsy*

19

What are the most common sites of metastasis for pancreatic adenocarcinoma?

- Lung
- Liver
- Peritoneum

20

What stage are patients in when they start to experience symptoms of pancreatic cancer?

T3= local invasion of bowel, bile duct, and major vessels

21

What is the tumor marker for pancreatic cancer?

CA19-9

22

Localization of pnacreatic cancer to which region of the pancreas is associated with earlier diagnosis?

Head of the pancreas

23

What is associated with decreased serial CA 19-9 levels following treatment?

Increased survival

24

What is the primary goal of treatment in pancreatic cancer?

Symptom control
- Pain
- Weight loss
- Pruritus

25

How is pain controlled in pancreatic cancer?

1) Opiates
2) Celiac plexus neurolysis

26

How is weight loss managed?

Replacement of pancreatic enzymes

27

How is pruritus managed?

Anti-histamines
SSRI
Bile-acid binding resins

28

What procedure is used to resect the pancreas?

"Whipple procedure" or pancreaticoduodenectomy

*Note that b/c of late stage diagnosis, 80-85% are NOT amenable to resection*

29

How is pancreatic cancer medically managed?

Chemotherapy
1) 5-FU
2) Gemcitabine

*Note that 5-FU + Radiation was just as good as 5-FU alone

30

Generally speaking, what is the impact of intervention in the prognosis for pancreatic cancer?

Minimal--surgery buys more months than chemo, but both are only getting the patient more MONTHS

31

How common are cystic neoplasms?

Rare

32

What are the symptoms of a cystic neoplasm?

- Bloating
- Weight loss
- Obstructive jaundice

33

What is the most common type of cystic neoplasm?

Mucinous cystadenomas and Cystadenocarcinomas

34

What are the clinical features of Mucinous cystadenomas and Cystadenocarcinomas?

- More common in middle aged women
- Usually in body or tail of pancreas

35

What is intraductal papillary mucinous neoplasm?

Pancreatic precursor tumor

36

What are the clinical features of Intraductal papillary mucinous neoplasms?

- Men 60+
- Recurrent pancreatitis from mucin obstructing the pancreatic duct

37

How are Cystic Neoplasms worked up?

1) Abdominal CT
2) EUS
3) Biopsy

38

What is the treatment for symptomatic, malignant or potentially malignant cystic neoplasms?

Surgical resection

39

List the various types of endocrine tumors.

- Insulinoma
- Gastrinoma
- Glucagonoma
- VIPoma
- Somatostatinoma

40

What is the most common type of endocrine tumor?

Insulinoma

41

What type of symptoms are seen with Insulinomas?

Generally, hypoglycemia in younger individuals

42

What is Whipple's Triad in Insulinomas?

1) Hypoglycemic sx.
2) Serum glucose less than 50 mg/dL
3) Relief with glucose adminstration

43

How is an Insulinoma diagnosed?

- 72 hour fast with insulin measurement
- Elevated c-peptide and proinsulin are confirmatory

44

What is the gold standard for imaging an insulinoma?

Intraoperative US and palpation

45

What is the typical presentation for Gastrinomas?

- Abdominal pain
- PUD
- GERD
- Diarrhea

46

How are Gastrinomas diagnosed?

1) Elevated serum gastrin
2) Secretin stimulation test

47

Where is the Gastrinoma triangle?

1) superior= cystic and common bile ducts
2) inferior= second and third parts of duodenum
3) medial= neck and body of the pancreas

48

How are Gastrinomas treated?

PPIs and surgical resection