EXAM #3: PANCREATIC CANCER Flashcards Preview

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Flashcards in EXAM #3: PANCREATIC CANCER Deck (48)
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1
Q
Where is pancreatic cancer more prevalent geographically?
A
In well developed countries
2
Q
What is the mortality associated with pancreatic cancer in the US?
A
4th leading cause of cancer mortality in the US

*Note that is also has the poorest prognosis of all cancers
3
Q
Where is the pancreas located?
A
Retroperitoneal in close proximity to the duodenum
4
Q
What are the two types of cells in the exocrine pancreas?
A
Acinar cells and duct cells
5
Q
What is the most common type of pancreatic cancer?
A
Adenocarcinoma arising from the exocrine pancreas (90%)
6
Q
How would you describe the histopathology of an adenocarcinoma?
A
- Well differentiated cuboidal cells
- Duct-like structures that contain mucin
7
Q
What oncogene is highly associated with pancreatic carcinoma?
A
K-ras (90%)
8
Q
What diseases are associated with pancreatic adenocarcinoma?
A
- FAP
- Peutz-Jeghers
- Von Hippel-Lindau
- MEN1
- HNPCC
- BRCA
- Familial atypical multiple mole melanoma (FAMMM)
9
Q
What are the non-genetic risk factors for pancreatic cancer?
A
- Age older than 45
- Chronic pancreatitis
- Smoking
- DM
- Diet high in fat/meat
10
Q
What chemical exposures are risk factors for pancreatic cancer?
A
B-naphthylamine
Benzidine
11
Q
What surgical history is a risk factor for pancreatic cancer?
A
Partial gastrectomy
12
Q
How does pancreatic cancer typically present?
A
1) Abdominal pain
2) Weight loss
3) Jaundice
4) Steatorrhea
5) Pruritus

*Elderly patient that develops glucose intolerance*
13
Q
How is pancreatic cancer diagnosed?
A
1) Spiral CT with IV contrast
- Determines mets and resectability
2) Confirm with biopsy
14
Q
What are the determinants of resectablilty in pancreatic cancer?
A
1) No extrapancreatic disease
2) No direct tumor extension into the celiac axis and SMA
15
Q
What is the utility of ERCP in pancreatic cancer?
A
1) Detection of small tumors not seen on CT
2) Palliation of biliary obstruction
16
Q
What sign on imaging is pathognomonic for pancreatic adenocarcinoma?
A
"Double-duct" sign
17
Q
What is EUS?
A
Endoscopic US
18
Q
What is the utility of EUS in pancreatic cancer?
A
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
Q
What are the most common sites of metastasis for pancreatic adenocarcinoma?
A
- Lung
- Liver
- Peritoneum
20
Q
What stage are patients in when they start to experience symptoms of pancreatic cancer?
A
T3= local invasion of bowel, bile duct, and major vessels
21
Q
What is the tumor marker for pancreatic cancer?
A
CA19-9
22
Q
Localization of pnacreatic cancer to which region of the pancreas is associated with earlier diagnosis?
A
Head of the pancreas
23
Q
What is associated with decreased serial CA 19-9 levels following treatment?
A
Increased survival
24
Q
What is the primary goal of treatment in pancreatic cancer?
A
Symptom control
- Pain
- Weight loss
- Pruritus
25
Q
How is pain controlled in pancreatic cancer?
A
1) Opiates
2) Celiac plexus neurolysis
26
Q
How is weight loss managed?
A
Replacement of pancreatic enzymes
27
Q
How is pruritus managed?
A
Anti-histamines
SSRI
Bile-acid binding resins
28
Q
What procedure is used to resect the pancreas?
A
"Whipple procedure" or pancreaticoduodenectomy

*Note that b/c of late stage diagnosis, 80-85% are NOT amenable to resection*
29
Q
How is pancreatic cancer medically managed?
A
Chemotherapy
1) 5-FU
2) Gemcitabine

*Note that 5-FU + Radiation was just as good as 5-FU alone
30
Q
Generally speaking, what is the impact of intervention in the prognosis for pancreatic cancer?
A
Minimal--surgery buys more months than chemo, but both are only getting the patient more MONTHS
31
Q
How common are cystic neoplasms?
A
Rare
32
Q
What are the symptoms of a cystic neoplasm?
A
- Bloating
- Weight loss
- Obstructive jaundice
33
Q
What is the most common type of cystic neoplasm?
A
Mucinous cystadenomas and Cystadenocarcinomas
34
Q
What are the clinical features of Mucinous cystadenomas and Cystadenocarcinomas?
A
- More common in middle aged women
- Usually in body or tail of pancreas
35
Q
What is intraductal papillary mucinous neoplasm?
A
Pancreatic precursor tumor
36
Q
What are the clinical features of Intraductal papillary mucinous neoplasms?
A
- Men 60+
- Recurrent pancreatitis from mucin obstructing the pancreatic duct
37
Q
How are Cystic Neoplasms worked up?
A
1) Abdominal CT
2) EUS
3) Biopsy
38
Q
What is the treatment for symptomatic, malignant or potentially malignant cystic neoplasms?
A
Surgical resection
39
Q
List the various types of endocrine tumors.
A
- Insulinoma
- Gastrinoma
- Glucagonoma
- VIPoma
- Somatostatinoma
40
Q
What is the most common type of endocrine tumor?
A
Insulinoma
41
Q
What type of symptoms are seen with Insulinomas?
A
Generally, hypoglycemia in younger individuals
42
Q
What is Whipple's Triad in Insulinomas?
A
1) Hypoglycemic sx.
2) Serum glucose less than 50 mg/dL
3) Relief with glucose adminstration
43
Q
How is an Insulinoma diagnosed?
A
- 72 hour fast with insulin measurement
- Elevated c-peptide and proinsulin are confirmatory
44
Q
What is the gold standard for imaging an insulinoma?
A
Intraoperative US and palpation
45
Q
What is the typical presentation for Gastrinomas?
A
- Abdominal pain
- PUD
- GERD
- Diarrhea
46
Q
How are Gastrinomas diagnosed?
A
1) Elevated serum gastrin
2) Secretin stimulation test
47
Q
Where is the Gastrinoma triangle?
A
1) superior= cystic and common bile ducts
2) inferior= second and third parts of duodenum
3) medial= neck and body of the pancreas
48
Q
How are Gastrinomas treated?
A
PPIs and surgical resection