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#Phase 2.1: GI > Pancreatic Cancer > Flashcards

Pancreatic Cancer Flashcards

1
Q

What are the risk factors for Pancreatic cancer? (7 things)

A
  1. Smoking
  2. Alcohol
  3. Carcinogens
  4. DM
  5. Chronic Pancreatitis
  6. High waist circumference
  7. High fat + Red / Processed meat diet
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2
Q

What type of cancer is Pancreatic cancer usually?

A

Ductal adenocarcinoma

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3
Q

What is a characteristic of Ductal adenocarcinomas? (2 things)

A
  1. Metastasize early

2. Present late

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4
Q

Which part of the pancreas do most pancreatic cancers arise in? (4 things)

A
  1. 60% = pancreas head
  2. 25% = pancreas body
  3. 15% = pancreas tail
  4. A few in ampulla of Vater / pancreatic islet cells
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5
Q

Which pancreatic cancer arises in the ampulla of Vater?

A

Ampullary tumour

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6
Q

Which pancreatic cancers arise in the pancreatic islet cells? (5 things)

A
  1. Insulinoma
  2. Gastrinoma
  3. Glucagonoma
  4. Somatostanimo
  5. VIPomas
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7
Q

Which pancreatic cancers have better prognosis than the rest? (2 things)

A
  1. Ampulla of Vater cancers

2. Pancreatic islet cell cancers

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8
Q

What is the genetic significance of pancreatic cancer?

A

95% have mutations in KRAS2 gene

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9
Q

Where do Pancreatic cancers spread to? (4 things)

A
  1. Liver (FIRST)
  2. Peritoneum
  3. Lungs
  4. Bones
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10
Q

What is the key CF that should make you instantly think of Pancreatic HEAD Cancer as a differential?

A

Painless Obstructive Jaundice

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11
Q

How does Pancreatic HEAD cancer cause Obstructive jaundice?

A

Tumour of pancreas HEAD grows and compresses bile ducts

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12
Q

What is the other DD of Painless Obstructive Jaundice?

A

Cholangiocarcinoma

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13
Q

What are the CF of Painless Obstructive Jaundice in Pancreatic HEAD Cancer? (4 things)

A
  1. Yellow skin + sclera
  2. Pale stools
  3. Dark urine
  4. Generalised itching
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14
Q

What do 75% of Pancreatic BODY / TAIL Cancers present with? (3 things)

A
  1. Epigastric pain
  2. Radiates to back
  3. Relieved by sitting forward
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15
Q

What are the other CF of Pancreatic Cancers? (10 things)

A
  1. Palpable gall bladder (Courvoisiers’s Sign)
  2. Ascites
  3. N + V + D
  4. Change in bowel habits
  5. Rastafarian lymphadenopathy
  6. Epigastric mass
  7. jAndince
  8. Splenomegaly + Hepatomegaly
  9. Weight loss (late)
  10. New onset DM / Worsening T2DM (late)
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16
Q

What is Courvoisier’s Sign in Pancreatic Cancer?

A

Enlarged, palpable, non-tender gallbladder

17
Q

What does Courvoisier’s Law state? (2 things)

A
  1. Palpable gallbladder with jaundice is UNLIKELY to be gallstones
  2. The cause is usually Pancreatic Cancer OR Cholangiocarcinoma
18
Q

How does Pancreatic Cancer cause Splenomegaly?

A

Cancer in BODY / TAIL –> splenic vein obst

19
Q

Which patients does NICE say you should refer for sus Pancreatic Cancer?

A
  1. 40+ yrs old w Jaundice = refer on 2 wk wait

2. 60+ yrs old w Weight Loss + 1 more of 7 NICE symptoms = refer for DIRECT ACCESS CT ABDO

20
Q

What are the 7 NICE symptoms that when present w Weight Loss in a 60+ yr old, must be referred for Direct Access CT Abdo? (7 things)

A
  1. N / V / D
  2. Constipation
  3. Abd / Back pain
  4. New onset diabates
21
Q

What investigations should be done for sus Pancreatic Cancer?

A
  1. Imaging (usually CT)
  2. Biopsy
  3. CA19-9 tumour marker
  4. MRCP
  5. ERCP
22
Q

What is the diagnosis of Pancreatic cancer based on? (2 things)

A
  1. Imaging (usually CT)

2. Biopsy

23
Q

What CT is done sus Pancreatic Cancer?

A

Staging CT TAP (thorax, abd, pelvis)

24
Q

What is the CT for sus Pancreatic Cancer used to look at? (2 things)

A
  1. Metastasis

2. Other cancers

25
Q

What tumour marker is used to assess PROGNOSIS of Pancreatic Cancer?

A

CA19-9

26
Q

Why is CA19-9 not used for DIAGNOSIS of Pancreatic Cancer? (2 things)

A
  1. It’s non specific

2. Also raised in Cholangiocarcinoma + other conditions

27
Q

What is MRCP used for in sus Pancreatic Cancer?

A

Assess biliary system to assess obstruction

28
Q

What is ERCP used for in sus Pancreatic Cancer? (3 things)

A
  1. Insert stent
  2. Relieve obstruction
  3. Obtain biopsy
29
Q

Where will the management of a Pancreatic cancer patient be decided?

A

Hepatobiliary (HPB) MDT meeting

30
Q

What percentage of Pancreatic Cancers are suitable for radical surgery?

A

Under 20% :(

31
Q

What are the Surgical options for Pancreatic Cancers? (4 things)

A
  1. Total pancreatectomy
  2. Distal pancreatectomy (body n tail) (done laparoscopically)
  3. Radical PancreaticoDuodenectomy (Whipple Procedure)
  4. Pylorus-Preserving PancreaticoDuodenectomy (PPPD) (modified Whipple Procedure)
32
Q

What is Whipple Procedure?

A

Surgery to remove Pancreas Head Tumour that HASN’T spread

33
Q

What does Whipple Procedure remove? (6 things)

A
  1. Pancreas head
  2. Duodenum
  3. Gallbladder
  4. Bile duct
  5. Relevant lymph nodes
  6. (Sometimes parts of Stomach + Pancreas Body)
34
Q

What is Pylorus-Preserving PancreaticoDuodenectomy (PPPD) (modified Whipple Procedure)?

A

Same as Whipple Procedure but you just leave the Pylorus of stomach in place

35
Q

What are the Palliative options for Pancreatic Cancers? (4 things)

A
  1. Stent insertion to relieve biliary obst
  2. Surgery to bypass biliary obst
  3. Palliative chemo / radio
  4. Opiates for pain (End of life)
36
Q

What is the mean survival time for Pancreatic Cancer?

A

Under 6 months :(

#Phase 2.1: GI (29 decks)

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