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Year Two - Gastroenterology System > Pancreatic Cancer > Flashcards

Pancreatic Cancer Flashcards

1
Q

What is pancreatic cancer?

A

It is defined as the proliferation of malignant cells in the pancreas

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2
Q

In most cases, what is the histology classification of pancreatic cancer?

A

Adenocarcinoma

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3
Q

In most cases, what region of the pancreas tends to be affected by pancreatic cancer?

A

Head of the pancreas

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4
Q

What are the eight risk factors of pancreatic cancer?

A

Older Age

Family History

Chronic Pancreatitis

Hereditary Non-Polyposis Colorectal Carcinoma

Multiple Endocrine Neoplasia

Diabetes Mellitus

Obesity

Smoking

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5
Q

What two genes are associated with pancreatic cancer?

A

KRAS-2

BRCA 2

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6
Q

What is the main gene associated with pancreatic cancer?

A

KRAS-2

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7
Q

What are the ten clinical features associated with pancreatic cancer?

A

Painless Jaundice

Palpable Gallbladder

Trousseau Sign

Pale Stools

Dark Urine

Steatorrhoea

Pruritus

Weight Loss

Hepatomegaly

Lymphadenopathy

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8
Q

What is the main clinical feature of pancreatic cancer?

A

Painless jaundice

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9
Q

Describe the epigastric pain associated with pancreatic cancer

A

It radiates to the back

It is relieved by sitting forward

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10
Q

What does Courvoisier’s Law state? How does this relate to pancreatic cancer?

A

It states that in the presence of painless jaundice, a palpable gallbladder is unlikely to be due to gallstones

This means that when both painless jaundice and a palpable gallbladder present - a diagnosis of pancreatic cancer is indicated

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11
Q

What is Trousseau’s sign?

A

It is defined as migratory thrombophlebitis

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12
Q

What is migratory thrombophlebitis?

A

It is is an inflammatory reaction of the vein accompanied by a thrombus

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13
Q

What is the pathophysiological cause of steatorrhoea?

A

Decreased lipase levels

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14
Q

What lymphadenopathy is associated with pancreatic cancer?

A

Virchow’s node

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15
Q

What is Virchow’s node?

A

It is the lymph node present in the left supraclavicular region

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16
Q

What are the four investigations used to diagnose pancreatic cancer?

A

Blood Tests

Ultrasound Scan

CT Scan

Endoscopic Retrograde Cholangiopancreatography (ERCP)

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17
Q

What are the six blood test results indicative of pancreatic cancer?

A

Increased CA19-9 Levels

Increased CEA Levels

Increased ALP Levels

Increased Bilirubin Levels

Increased GGT Levels

Increased Glucose Levels

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18
Q

What two tumour markers are associated with pancreatic cancer?

A

CA19-9

CEA

19
Q

What is the main tumour marker associated with pancreatic cancer?

A

CA19-9

20
Q

CA19-9 is non-specific. What other four conditions are associated with increased CA19-9 levels?

A

Gastrointestinal malignancies

Liver cirrhosis

Pancreatitis

Inflammatory bowel disease

21
Q

How are ultrasound scans used to manage pancreatic cancer?

A

They are used to assess for pancreatic cancer tumours, as well as any associated complications

22
Q

Why can ultrasound scans produce false negative results of pancreatic cancer?

A

The pancreas is positioned behind gas-filled bowel loops and intraperitoneal fat

23
Q

What is the gold standard investigation used to diagnose pancreatic cancer?

A

CT scan

24
Q

What sign on CT scans is associated with pancreatic cancer? What does this suggest?

A

Double duct sign

This suggests simultaneous dilation of the common bile and pancreatic ducts

25
Q

CT scans can be used to obtain guided biopsies of pancreatic cancer. Why do we avoid this in resectable tumours?

A

This is due to the risk of seeding cancer cells within the peritoneal cavity

26
Q

What is ERCP?

A

It involves the insertion of an endoscope through the oesophagus, stomach and into the duodenum

In the duodenum, the endoscope is then guided through the sphincter of Oddi into the bile duct – where contrast is injected, and x-rays are then taken

27
Q

How is ERCP used to investigate pancreatic cancer?

A

Brushings for cytology

OR

Biopsies for histopathological diagnosis

28
Q

What are the four surgical management options used in pancreatic cancer?

A

Pancreatoduodenectomy

Distal Pancreatotomy

Total Pancreatotomy

Endoscopic Retrograde Cholangiopancreatography (ERCP)

29
Q

What is another term for pancreatoduodenectomy?

A

Whipple’s resection

30
Q

What is pancreatoduodenectomy?

A

It involves surgical removal of the head of the pancreas, duodenum, common bile duct and gallbladder – with or without extended dissection of additional lymph nodes

31
Q

What two incisions are used in pancreatodudodenectomy?

A

Rooftop

Midline

32
Q

What are the two complications following pancreatoduodenectomy?

A

Dumping syndrome

Peptic ulcer disease

33
Q

How do we restore gastrointestinal function following pancreatoduodenectomy?

A

We create a Roux en-Y loop from a segment of jejunum to enable anastomosis

34
Q

What three anastomosis are formed with a Roux en-Y loop?

A

Pancreatojejunostomy

Hepaticojejunostomy

Duodenojejunostomy

35
Q

What is a pancreatojejunostomy?

A

It enables drainage of pancreatic secretions into the small bowel

36
Q

What is a hepaticojejunostomy?

A

It enables drainage of bile secretions into the small bowel

37
Q

What is a duodenojejunostomy?

A

It enables restoration of the gastrointestinal tract continuity

38
Q

What is a distal pancreatotomy?

A

It involves resection of the body/tail of the pancreas, as well as the spleen

39
Q

When is distal pancreatotomy recommended?

A

It is recommended in cases where malignancy is confined to the body/tail of the pancreas

40
Q

What is total pancreatotomy?

A

It involves resection of the whole pancreas, as well as the duodenum, common bile duct, gallbladder and spleen

41
Q

When is total pancreatotomy recommended?

A

It is recommended in cases where malignancy is diffuse or confined to pancreas, involving the neck region

42
Q

How is ERCP used to manage pancreatic cancer?

A

It can be used to insert a sent into the bile duct to relieve compression caused by pancreatic cancer

This enables drainage of bile

43
Q

When is ERCP recommended as a management option?

A

It is used as a palliative management option to provide symptomatic relief

44
Q

How is chemotherapy used to manage pancreatic cancer?

A

It can be administered adjuvantly, in combination with management techniques to improve the likelihood of success

Year Two - Gastroenterology System (33 decks)

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