04b: Pancreatic, Hepatic

Question 1

Pancreatic cancer is number (X) on list of common cancers and number (Y) on list of cancer death causes.

Answer 1

X = 12
Y = 4

Question 2

Pancreatic cancer: (X)% of patients have potentially curable/resectable lesions. Of these, (Y)% achieve 5y survival.

Answer 2

X = 15-20
Y = 10-30

Question 3

Pancreatic cancer: median survival with resection is…

Answer 3

20-24 months

Question 4

List the Pancreatic cancer RFs. Star the best-established factor.

Answer 4

1. Age, M, AA
2. Chronic or hereditary Pancreatitis
3. Smoking*
4. High meat/fat diet; DM
5. Genetics (BRCA2/1, Lynch, Peutz-Jeghers)

Question 5

T/F: 40% of patients with hereditary pancreatitis will develop pancreatic cancer by age 70.

Answer 5

True

Question 6

T/F: Screening for pancreatic cancer has proven overall nonbenefical.

Answer 6

False - rarely indicated, but benefit seen for pts with hereditary pancreatitis

Question 7

Most, (X)%, of pancreatic cancers are (exo/endo)-crine and located at (head/tail) of pancreas.

Answer 7

X = 95
Exocrine
Head (60-70%)

Question 8

Most common specific type of pancreatic tumor is:

Answer 8

Ductal adenocarcinoma

Question 9

Which common mutation is found in up to 90% of pancreatic tumors?

Answer 9

KRAS

Question 10

Pancreatic cancer: list Sx associated with head/neck lesion that obstructs (X).

Answer 10

X = bile duct;

Painless jaundice, abd pain, N/V

Question 11

Pacnreatic cancer: Sx of pancreatitis, abdominal/back pain indicative of mass in (X) location, obstructing (Y).

Answer 11

X = head/neck/body
Y = Pancreatic duct

Question 12

Which Sx are common to ALL pancreatic cancer lesions?

Answer 12

Fatigue, anorexia, weight loss

Question 13

Pancreatic cancer: preferred modality for diagnosis and staging.

Answer 13

Triple phase CT

Question 14

Pancreatic cancer: most common surgical Rx

Answer 14

Whipple (Pancreatoduodenectomy with reconstruction)

Question 15

Overall, (X)% of patients diagnosed with pancreatic cancer are alive after 5 years.

Answer 15

X = 5-7

Question 16

Patients with locally advanced pancreatic cancer are treated with:

Answer 16

Chemo (5FU)/radiation (palliative and small survival benefit)

Question 17

Patients with metastatic pancreatic cancer are treated with:

Answer 17

Chemo (gemcitabine; modest palliative benefit)

Question 18

Pancreatic cancer: what are two procedures that can be done for palliative care?

Answer 18

1. ERCP with CBD stenting (relieve pain/jaundice)

2. Neurolysis of celiac plexus (EUS-guided alcohol injection)

Question 19

Hepatocellular carcinoma (HCC) is number (X) on list of worldwide causes of cancer death.

Answer 19

X = 4

Question 20

Geographic variation of HCC primarily due to variance in:

Answer 20

Hep B infection

Question 21

HCC often diagnosed (early/late) with median survival of (X) at diagnosis.

Answer 21

Late

X = 6-20 months

Question 22

HCC RFs:

Answer 22

1. Male (4:1)
2. Viral hepatitis (B/C)
3. Cirrhosis
4. Aflatoxin

Question 23

Universal symptoms for HCC

Answer 23

There are none.. usually asymptomatic; maybe weight loss, ascites, palpable mass, jaundice?

Question 24

HCC metastatic spread is usually to:

Answer 24

lungs and bone

Question 25

Who should be screened for HCC?

Answer 25

1. Cirrhosis (of any etiology)

2. HBV pts (Asian M over 40 or F over 50, AA over 20, FHx of HCC, high viral load/ALT)

Question 26

HCC screening done how often? Using which methods? Star the most reliable/accurate one.

Answer 26

6 month intervals;

1. RUQ ultrasound*
2. Serum alpha-fetoprotein (AFP)

Question 27

HCC: serum (X) levels used for screening with moderate specificity, since (Y) tumors can also secrete (X).

Answer 27

X = alpha-fetoprotein
Y = germ cell

Question 28

HCC: alpha-fetoprotein level of (X) is essentially diagnostic

Answer 28

X = over 500 ng/mL

Question 29

HCC: if screening test abnormal, what’s the next step?

Answer 29

Obtain 3-phase CT or contrast-enhanced MRI to confirm diagnosis (no need to biopsy)

Question 30

Most cysts of pancreas are (benign/malignant), caused by (X).

Answer 30

Benign;

X = pancreatitis

Question 31

(X) pancreatic cysts are 20x more common in women than in men and are (benign/malignant).

Answer 31

X = mucinous cystic neoplasms

Can be benign, borderline, or malignant (MUST be resected and examined for carcinoma)

Question 32

(X) pancreatic cysts are always benign neoplasms composed of (Y) cells that line small lobules filled with (Z).

Answer 32

X = serous cystadenomas
Y = glycogen-rich low-cuboidal 
Z = thin, clear, straw-colored fluid

Question 33

(X) pancreatic cyst can be distinguished from mucinous cystic neoplasms by which two features?

Answer 33

X = intraductal papillary mucinous neoplasm (IPMN)

1. No “ovarian” stroma
2. Located in main pancreatic duct

Question 34

T/F: Pancreatic endocrine neoplasms are always malignant.

Answer 34

False - can also be benign

Question 35

List the criteria that definitively diagnose a pancreatic endocrine neoplasm as malignant:

Answer 35

1. Metastases (lymph nodes or beyond)
2. Vascular invasion
3. Invasion of adjacent viscera

Question 36

T/F: 90% of insulinomas are benign.

Answer 36

True

Question 37

Most common pancreatic endocrine neoplasm

Answer 37

Beta cell tumor (insulinoma)

Question 38

(X) pancreatic endocrine neoplasm is usually invasive/metastatic, with 25% of cases arising in conjunction with other endocrine tumors due to (Y) syndrome.

Answer 38

X = ZES (gastrinoma)
Y = MEN1 (multiple endocrine neoplasia)

Question 39

Inactivation of which tumor suppressor genes is seen in most pancreatic carcinomas?

Answer 39

1. p16 (95% of cases)
2. SMAD4 (50%)
3. p53 (75%)