Flashcards in EXAM #3: PANCREATIC CANCER Deck (48)
Where is pancreatic cancer more prevalent geographically?
In well developed countries
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
Where is the pancreas located?
Retroperitoneal in close proximity to the duodenum
What are the two types of cells in the exocrine pancreas?
Acinar cells and duct cells
What is the most common type of pancreatic cancer?
Adenocarcinoma arising from the exocrine pancreas (90%)
How would you describe the histopathology of an adenocarcinoma?
- Well differentiated cuboidal cells
- Duct-like structures that contain mucin
What oncogene is highly associated with pancreatic carcinoma?
What diseases are associated with pancreatic adenocarcinoma?
- Von Hippel-Lindau
- Familial atypical multiple mole melanoma (FAMMM)
What are the non-genetic risk factors for pancreatic cancer?
- Age older than 45
- Chronic pancreatitis
- Diet high in fat/meat
What chemical exposures are risk factors for pancreatic cancer?
What surgical history is a risk factor for pancreatic cancer?
How does pancreatic cancer typically present?
1) Abdominal pain
2) Weight loss
*Elderly patient that develops glucose intolerance*
How is pancreatic cancer diagnosed?
1) Spiral CT with IV contrast
- Determines mets and resectability
2) Confirm with biopsy
What are the determinants of resectablilty in pancreatic cancer?
1) No extrapancreatic disease
2) No direct tumor extension into the celiac axis and SMA
What is the utility of ERCP in pancreatic cancer?
1) Detection of small tumors not seen on CT
2) Palliation of biliary obstruction
What sign on imaging is pathognomonic for pancreatic adenocarcinoma?
What is EUS?
What is the utility of EUS in pancreatic cancer?
1) Aid in diagnosis and characterization of lesion
*EUS biopsy is associated with LESS peritoneal seeding compared to percutaneous CT guided biopsy*
What are the most common sites of metastasis for pancreatic adenocarcinoma?
What stage are patients in when they start to experience symptoms of pancreatic cancer?
T3= local invasion of bowel, bile duct, and major vessels
What is the tumor marker for pancreatic cancer?
Localization of pnacreatic cancer to which region of the pancreas is associated with earlier diagnosis?
Head of the pancreas
What is associated with decreased serial CA 19-9 levels following treatment?
What is the primary goal of treatment in pancreatic cancer?
- Weight loss
How is pain controlled in pancreatic cancer?
2) Celiac plexus neurolysis
How is weight loss managed?
Replacement of pancreatic enzymes
How is pruritus managed?
Bile-acid binding resins
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*
How is pancreatic cancer medically managed?
*Note that 5-FU + Radiation was just as good as 5-FU alone