75. Pancreatic adenocarcinoma

Question 1

origin / histology

Answer 1

arising form pancreatic ducts

histology: disorganized glandular structure with cellular infiltration

Question 2

prognosis ( why)

Answer 2

average survival 1 year after diagnosis –> very aggressive , often metastatic at presentation

Question 3

risk factors

Answer 3

1. TObacco
2. chronic pancreatitis ( esp >20 years
3. Diabetes
4. > 50 age
5. Jewish and African american males

Question 4

clinical presentation

Answer 4

1. abdominal pain radiating to back
2. weight loss ( malabsoroption and anorexia )
3. migratory thromboplenitis ( trousseau syndrome)
4. obstructive jaundice ( and pale stool) with Courvoisier sign ( if at head)
5. secondary DM ( if at body or tail)

Question 5

Trousseau syndrmoe ? ( and frequency )

Answer 5

Migratory thrombophlebitis –> redness and tenderness on palpation of extremities ( seen in 10%)

Question 6

courvoisier sign

Answer 6

presence of a palpably enlarged gallbladder which is nontender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones

Question 7

treatment

Answer 7

1. Whipple procedure ( en bloc removal of the head and neck of pancreas, proximal duodenum, gallabladder)
2. chemotherapy
3. radiation therapy

Question 8

markers

Answer 8

1. CA 19-9

2. CEA ( not specific)

Question 9

CEA as a marker

Answer 9

not specific

1. colocrecta ca (70%)
2. pancreatic ca (70%)
3. gastric ca
4. breast ca
5. medullary thyroid ca

Question 10

• You diagnose a woman with pancreatic adenocarcinoma and she immediately asks about the prognosis. How do you respond?

Answer 10

The prognosis is poor—average survival is ~1 year after diagnosis, as it has typically already metastasized at the time of diagnosis

Question 11

• A patient presents with weight loss, night sweats, and painless jaundice. Where is the tumor most likely located?

Answer 11

The pancreatic head (jaundice with a nontender, palpable gallbladder is the Courvoisier sign, associated with pancreatic adenocarcinoma)

Question 12

• A mass is found on the head of the pancreas of a patient. What abnormal lab findings would be expected?

Answer 12

Increased alkaline phosphatase and bilirubin levels, indicating obstructive jaundice

Question 13

• Obstructive jaundice with a palpable, nontender gallbladder on abdominal exam is known as what?

Answer 13

Courvoisier sign (associated with pancreatic adenocarcinoma, but also possibly due to other acute distal bile duct obstructions)

Question 14

• You find redness and tenderness on palpation of the extremities in a patient with pancreatic adenocarcinoma. What is this sign called?

Answer 14

Trousseau syndrome, or migratory thrombophlebitis

Question 15

• What two ethnic groups have an increased risk for pancreatic cancer?

Answer 15

Jewish and African-American male groups

Question 16

• Which two tumor markers are commonly associated with pancreatic cancer? Which is more specific for the disease?

Answer 16

CA 19-9 (more specific) and carcinoembryonic antigen (CEA is less specific)

Question 17

• Which is most likely to be a risk factor for pancreatic cancer: alcohol, cigarettes, or sulfa drugs?

Answer 17

Cigarettes

Question 18

• What causes the weight loss associated with pancreatic adenocarcinoma?

Answer 18

Malabsorption and anorexia due to the disorganized glandular structure of the pancreas