Pancreatic CA Flashcards by tcarlso 3

Where does pancreatic cancer rank among the mortality of CA?

4th

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Where does the pancreas sit in the abdomen?

Retroperitoneal space

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Which part of the pancreas comprises the majority of the tissue (exo or endocrine)?

Exocrine

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What are the stages T1-T4 of pancreatic tumors?

T1 = less than 2 cm
T2 = greater than 2 cm
T3 = Invades into duodenum, bile duct major veins
T4 = invades large arteries, stomach, spleen

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What type of tumors arise from the pancreas?

Adenocarcinomas

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What is the histology of the adenoCA of the pancreas?

Well differentiated cuboidal cells with duct-like structures that contain mucin

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What is the oncogene that is present in the majority of adenoCAs?

KRAS

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What are the two oncogenes that are activated in many pancreatic cancers?

Kras and AKT2

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What are the three tumor suppressor genes that are mutated in pancreatic cancers?

p16
p53
DPC4

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What percent of pts with pancreatic ca have a family h/o it?

7-8%

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What are the associated family genetic mutations that are associated with pancreatic CA?

Familial adenomatous polyposis

Peutz-Jegeh

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What is the genetic mutation associated with peutz-jeghers syndrome

STK11

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Pancreatic cancers are rare below what age?

45 yo

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What are the diseases that predispose pts to

Chronic pancreatitis

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What are the chemical that predispose pts to pancreatic cancers?

beta-naphthylamine

Benzidine

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What is the diet that can predispose to pancreatic cancer?

High in fats and meats

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What ethnicity has a higher rate of pancreatic cancer?

Blacks

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What is the usual presentation of pancreatic cancer?

Jaundice
weight loss
Abdominal pain

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New onset DM I in an older pt is concerning for what?

Pancreatic tumor that obliterate the beta cells

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What is the cause of hyperbilirubinemia in pts with pancreatic cancer?

mass effect on common bile duct

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Tumors of which part of the pancreas usually present with pain?

Tail or body

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How do you diagnose pancreatic tumors?

Imaging (CT especially)

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Why are pancreatic cancers particularly deadly?

Not symptomatic until late

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What is the best test for determining the resectability of a pancreatic cancer? What determines resectability?

No extrapancreatic disease
No extension to the celiac axis or SMA

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What happens to the common bile duct and pancreatic duct in pancreatic tumors?

Dilation

What can ERCPs be utilized for?

Detecting small tumors not visualized on CT

What is the radiological sign of a pancreatic CA in the head of the pancreas?

Double duct sign | dilation of the pancreatic and bile duct

What is the role of an endoscopic ultrasound for pancreatic cancers?

Aids in diagnosis and characterization of lesions, as well as allows for biopsies

What are the three common met sites for pancreatic cancer?

Liver ***Peritoneum*** Lungs

What level of bilirubin causes jaundice?

Greater than 2 mg/dL

What is stage I pancreatic cancer?

Isolated lesion

What is stage II pancreatic cancer?

Invasion of the bowel or lymph node

What is stage III pancreatic cancer?

Very close to a vascular structure

What is the main markers of pancreatic cancer?

CA19-9

What are the ssx of pancreatic cancer?

back pain Weight loss Jaundice

Back pain with pancreatic cancer usually suggests what?

invasion of local structures

Decrease in CA 19-9 correlates with what?

Survival rates increase

What is the value of CA 19-9?

Following pts with CA | Differentiating between pancreatic CA and pancreatitis

What are the main chronic symptoms with pancreatic cancer? (4)

Pain Weight loss Pruritus Need for pancreatic enzyme replacement

What is the standard surgical procedure for pancreatic cancer? What is done in this?

Whipple----cholecystectomy + duodenectomy + pancreatectomy (head only)

What is the prognosis for pts who undergo the Whipple procedure for pancreatic cancer?

only live for about 15 months longer

What are the drugs that are used for pancreatic cancer?

5FU (maybe) | Gemcitabine

What is the drug that has shown some better prognosis when added to Gemcitabine for pancreatic cancer?

Erlotinib

Why is it hard for chemotherapeutic agents to attack pancreatic cancer?

Dense and highly fibrotic tissue

What is the rare pancreatic CA type?

Cystic neoplasm

What are the ssx of cystic neoplasm?

Malabsorption (lack of enzymes) Obstructive jaundice Recurrent pancreatitis

What is the chemical that is produce by the majority of cystic neoplasms of the pancreas?

Mucin

Where are cystic tumors of the pancreas usually found?

body or tail

How do you diagnose cystic pancreatic CA?

Abdominal CT EUS Biopsy

What are the tumors that arise from the islets of langerhans?

Pancreatic neuroendocrine tumors

What is the origin of endocrine tumors of the pancreas? What are the kinds (5)?

Neuroendocrine cells - insulinoma - gastrinoma - Glucagonoma - VIP secreting tumor - Somatostatinoma

What is the most common endocrine tumor of the pancreas? Ssx?

Insulinoma | Hypoglycemia ssx

What is whipple's triad?

Signs of insulinoma: 1. symptoms of hypoglycemia during fasting or exercise 2. Serum glucose less than 50 mg/dL during ssx 3. Relief of symptoms with glucose

What are the two tests that are useful for diagnosing insulinomas (besides BG and insulin levels)?

Anti-Insulin antibodies | C-peptide levels

What is the best way to diagnose a insulinoma?

us and palpation

What are the ssx of zollinger-ellison syndrome?

Recurrent ulcerations secondary to hypergastrinemia

What is the treatment for zollinger-ellison syndrome?

PPIs | Surgical resection

What are the vertices of the gastrinoma triangle?

Junction of: - head and body of pancreas - 2nd and 3rd part of the duodenum - cystic and bile duct

True or false: pts with peritoneal intrusion of pancreatic CA are considered to have metastatic disease

True

Why is it better to have CA in the head of the pancreas as opposed to the body or tail?

More likely to develop ssx early

True or false: most pancreatic cancers are too far advanced by the time of diagnosis to be resected

True

When is chemoradiation indicated for Pancreatic cancer?

Palliation of pain

What is the role of the hedgehog pathway in pancreatic cancer?

Important in stromal cell proliferation

What is the MOA of ruxolitinib?

JAK2 inhibitor used in the treatment of some pancreatic cancers

In whom are mucinous cystadenomas or the pancreas more common? Where are these located? How often do these lead to invasive cancer?

- Middle aged women - Usually body or tail - Frequent progression to invasive CA

In whom are intraductal papillary mucinous neoplasms of the pancreas more common? Ssx? Treatment?

Men over 60 yo Recurrent pancreatitis Surgical resection

What is the treatment for Zollinger-Ellison?

PPIs | Surgic resection

Pancreatic CA Flashcards

(67 cards)