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Flashcards in pancreatic cancer Deck (23)
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1
Q

what are the four tissues that adenocarcinoma can arise from in the pancreas ?

A

head of pancreas
distal bile duct
ampulla of vater
periampullary duodenum

2
Q

which tissue origin gives the best prognosis ?

A

ampulla

3
Q

what is the typical presentation of pancreatic carcinoma ?

A
jaundice
pain
weight loss 
anorexia 
nausea with or without vomiting 
abdominal and/or back pain
4
Q

when can pancreatic carcinoma not produce jaundice ?

A

when theres a carcinoma of the distal pancreas they dont produce jaundice until they metastasize so they present late

5
Q

what are the physical findings in the early stage of the disease ?

A

palpable gallbladder (Courvoisier’s sign)

6
Q

what are the physical findings in the late stages of the disease ?

A
cachexia 
ascites 
left supraclavicular adenopathy 
palpable abdominal mass 
migrating thrombophlebitis
7
Q

what is the normal bilirubin level ?

A

less thann 1

8
Q

what are the lab findings in pancreatic carcinomas ?

A

elevated serum bilirubin

elevated alkaline phosphatase

9
Q

what is the most specific tumor marker in pancreatic carcinomas ?

A

CA19-9

10
Q

which vessel is the head of the pancreas related to ?

A

superior mesenteric vessels

11
Q

which vessel is more likely to be invaded when it comes to cancer head of pancreas ?

A

superior mesenteric vein , the artery is less likely to be invaded

12
Q

what type of imaging modalities can we use to diagnose pancreatic cancers ?

A

PET CT

CT

13
Q

how do we take a biopsy of the pancreas ?

A

trans-duodenal guided ultrasound

14
Q

what are the clinical criteria for pancreatic resection ?

A
intrapancreatic carcinoma 
local invasion n
vascular invasion 
extrapancreatic nerve plexus invasion n
peritoneal metastasis 
liver metastasis
15
Q

what is whipple’s procedure ?

A

pancreaticodudonectomy

16
Q

when can we perform a total pancreatectomy ?

A

inn certain diseases such as mucinous adenocarcinoma

17
Q

what is kocherization of the duodenum ?

A

maneuver to mobilize the duodenum before performing other procedures locally or before incising the duodenum

18
Q

what is the problem with a complete pancreatectomy ?

A

incurable diabetes

19
Q

what other procedures can performed in cases of cancer head of pancreas?

A

pancreatico-jejunostomy

pancreatico-gastrotomy

20
Q

what molecular targeted therapy can nbe used inn pancreatic cancers ?

A

bevacizumab

cetuximab

21
Q

what is the initial study of choice in pancreatic cancers ?

A

CT

22
Q

what is the initial therapy for biliary obstruction?

A

endo-billiary stenting

23
Q

when should we consider Whipple’s procedure ?

A

only in patients showing resectable tumor on high quality CT