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GIR Test 3 > B5-100 Pancreatic Cancer > Flashcards

B5-100 Pancreatic Cancer Flashcards

1
Q

exocrine cells of the pancreas

A

acinar cells

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2
Q

endocrine cells of the pancreas

A

islet of langerhans

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3
Q

endocrine secretions of the pancreas

4

A
  • insulin
  • glucagon
  • somatostatin
  • pancreatic polypeptide
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4
Q

exocrine secretion of the pancreas

3

A
  • pancreatic amylase
  • proteases
  • lipase
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5
Q

risk factors for pancreatic cancer

3

A
  • smoking
  • high body mass, lack of physical activity
  • diabetes mellitus
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6
Q

most pancreatic cancer begins in the […] of the pancreas

A

head

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7
Q

tumors in the head of pancreas more commonly present with

3

A
  • jaundice
  • steatorrhea
  • weight loss
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8
Q

descibe pain characteristic of pancreatic cancer

A
  • insidious onset
  • gnawing, visceral epigastric pain
  • radiates to both sides of back
  • worse when lying down, after meal, at night
  • improves with sitting forward
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9
Q

25% of pancreatic cancer is heralded by new onset

A

diabetes mellitus

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10
Q

pruritis
dark urine
and pale stool are signs of

A

jaundice

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11
Q

thromboembolic events occur more commonly with tumors in the […] of the pancreas

A

body/tail

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12
Q

typical sites of metastasis of pancreatic cancer

3

A

liver
peritoneum
lungs

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13
Q

jaundice from pancreatic cancer is caused by […] hyperbilirubinemia

A

conjugated

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14
Q
  • most frequently mutated gene
  • presenting in >90% of cases
A

activating KRAS

D>V>C

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15
Q

[…] inactivation occurs in 95% of pancreatic cancer

loss of checkpoint

A

p16/CDKN2A

tumor suppressors

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16
Q
  • inactivation in 75-80% of pancreatic cancer
  • inactivation through LOH
  • loss of regulation of proliferation/apoptosis
A

p53

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17
Q
  • inactivation in 50% of pancreatic cancer
  • inactivation through LOH
  • inhibition of TGFb and BMP signaling pathways
A

SMAD4

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18
Q

used diagnostically to suggest pancreas as possible primary with mets of unknown site

gene

A

SMAD4

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19
Q

most common cause of familial pancreatic cancer

A

BRCA2/1

PALB2 less frequent

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20
Q

BRCA and PALB2 mutations are sensitive to what therapies?

A

PRAP inhibitor
mitomycin
platinum chemo drugs

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21
Q
  • germline mutation of tumor suppressor
  • regulates cell polarity
  • PJS
A

STK I

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22
Q

for a patient presenting with epigastric pain we should get […] to evaluate for pancreatitis

lab

A

serum lipase

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23
Q
  • intital imaging for patients with jaundice
  • high sensitivity for biliary obstruction and pancreatic mass > 3cm
A

transabdominal ultrasound

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24
Q

first test for patients with jaundice and a high suspicion of choledocholithiasis

A

ERCP or MRCP

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25
Q
  • most widely used and most sensitive imaging modality for evaluation of pancreatic cancer
  • can detect tumor <2cm
A

CT

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26
Q

preferred intital imaging in patients without jaundice

A

CT

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27
Q

used to guide biopsies when histological confirmation is needed

A

EUS

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28
Q

if the tumor involves the SMA, celiac axis, and/or common hepatic it is T[..] regardless of size

staging

A

T4

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29
Q

N category of staging assesses

A

regional lymph node involvement

  • NX- cannot be assessed
  • N0- none
  • N1- 1 to 3 lymph nodes
  • N2- 4+ lymph nodes
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30
Q

M category of staging assesses

A

distant metastasis

M0- none
M1- distant metastasis

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31
Q

if tumor is M1, it is stage […] regardless of T or N

A

4

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32
Q

treatment for metastatic disease

first and second line

A

first: folfirinox or gemcitabine
second: folfox

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33
Q

treatment for non-metastatic resectable disease

A

resect
gemcitabine

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34
Q

treatment for non-metastatic, non-resectable disease

A

folfirinox

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35
Q

what makes a patient a candidate for resection?

A
  • limited to pancreas
  • limited nodal involvement
  • limited vascular involvement

only 15-20% are resectable

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36
Q

why do only 38% of patients with resectable disease receive surgery?

A
  • low SES
  • physician pessimism regarding prognosis
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37
Q

most commonly used procedure for resectable pancreatic cancer

A

Whipple

pancreaticoduodenectomy

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38
Q

postoperative complications of resecting pancretic cancer

3

A
  • delayed gastric empyting
  • pancreatic fistulas
  • wound infections
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39
Q

is a standard or extended lymphadenectomy the preffered operation?

A

standard

extended shows no benefit and may have worse outcomes

40
Q

if a pancreatic tumor in the body/tail is deemed resectable (rare), what procedure is performed?

A

distal subtotal pancreatectomy with combine splenectomy

41
Q

mutations associated with pancreatic NETs

2

A

PTEN
MEN1

42
Q

what functional PanNET causes hypoglycemia?

A

insulinoma

43
Q

what functional PanNET causes Zollinger Ellison and steatorrhea?

ulcers in unsual places

A

gastrinoma

44
Q

what functional PanNET causes watery diarrhea, hypokalemia, and achlohydria?

A

VIPoma

45
Q

what functional PanNET causes diabetes mellitus and necrolytic migratory erythema?

A

glucagonoma

46
Q

what functional PanNET causes DM, steatorrhea, and hypochlorhydria?

A

somatostatinoma

47
Q

VIPoma is due to a tumor in what cell type?

A

D1

48
Q

treatment for most functional PanNETs

A

somatostatin analogs (octreotide)

49
Q

which type of pancreatic adenocarcinoma precusor lesion is able to be radiographically detected?

A

cystic lesions

50
Q

PanIN-1A mutations

A

ERBB2
KRAS

51
Q

PanIN-2 mutation

A

CDKN2A

52
Q

PanIN-3 mutations

A

tp53
SMAD4
BRCA2

53
Q

tumer diameter <2cm

T_

A

T1

54
Q

maximum tumor diameter greater than 2 cm less than 4 cm

T_

A

T2

55
Q

maximum tumor diameter >4 cm

T_

A

T3

56
Q
  • fatigue
  • shakiness
  • hunger
  • irritability

symptoms of

A

insulinoma

57
Q
  • gastric ulcers
  • abdominal pain
  • nausea
  • vomiting
  • elevated serum gastrin
A

gastrinoma

58
Q
  • thirst
  • frequent urination
  • abdominal pain

symptoms of

A

glucagonoma

hyperglycemia

59
Q

imaging modality used to monitor functional NETs

A

dotatate PET/CT

60
Q
  • amylase: low
  • CEA: low
  • CA72-4: low
  • CA 19-9: variable
  • CA 125: low
A

serous cystadenoma

61
Q
  • amylase: low
  • CEA: high
  • CA72-4: high
  • CA 19-9: variable
  • CA 125: variable
A

mucinous cystic neoplasm

62
Q
  • amylase: high
  • CEA: high
  • CA72-4: high
  • CA 19-9: variable
  • CA 125: low
A

IPMN

63
Q
  • amylase: high
  • CEA: low
  • CA72-4: low
  • CA 19-9: high
  • CA 125: low
A

pseudocyst

64
Q

most common type of pancreatic cancer?

A

ductal adenocarcinoma

65
Q

most common symptoms in pancreatic cancer

3

A

jaundice
weight loss
epigastric pain

66
Q

what gene mutation may have a better response to checkpoint inhibitor treatment?

A

MLH1/MSH2/6

defects in DNA mistmatch repair respond better

67
Q

what organs are involved in a whipple?

5

A
  • distal stomach
  • duodenum
  • head of pancreas
  • common bile duct
  • gallbladder
68
Q

an immune checkpoint inhibitor can be used in what mutations?

A

DNA mistmatch repair

MLH/MSH

69
Q

biomarker for pancreatic cancer

A

CA 19-9

70
Q

new onset diabetes is an independent risk factor for

A

pancreatic cancer

71
Q

hemolysis causes elevation of […] bilirubin

A

unconjugated

72
Q
  • ducts lined by a single layer of epithelial cells
  • significant collagen within the walls of some ducts
  • well organized ductal structure
A

normal pancreas

73
Q

cells with large nuclear/cytoplasm ratio and marked nuclear polymorphism

A

pancreatic ductal adenocarcinoma

74
Q

“drunken honeycomb”

A

pancreatic ductal adenocarcinoma

75
Q
A

pancreatic ductal adenocarcinoma

left: normal honeycomb, right: drunken honeycomb

76
Q

recommendation for treatment with low ECOG and favorable cormobidities

A

chemotherapy

77
Q

metastasis is a […] to surgery

A

contraindication

78
Q

when there is mismatch repair deficiency or microsatellite instability, what treatment can be used?

A

checkpoint inhibitors (PD1)

79
Q

treatment for known HRR deficiency

A

PARP inhibitors

80
Q

more than 180 involvement of SMV or portal vein but lacks contact with other vasculatures

A

borderline resectable

81
Q

what is removed during a Whipple?

A
  • distal stomach
  • duodenum
  • head of pancreas
  • gallbladder
  • part of common bile duct
82
Q

tumor is in contact with aorta

A

unresectable

83
Q

what is the advantages of PPPD?

A
  • reduced blood loss during surgery
  • shorter operating time
84
Q

are most PNNs functional or nonfunctional?

A

nonfunctional
70%

85
Q

a tumor in the head of the pancreas is in close proximity to what parts of the duodenum?

3

A

superior
descending
horizontal

86
Q

what part of the duodenum is near the body and tail of the pancreas?

A

ascending

87
Q

why is the stomach less likely to be invaded by pancreatic cancer?

A

it is intraperitoneal and can move

88
Q

two arteries that supply the head of the pancreas

A

gastroduodenal
superior mesenteric

89
Q

supplies body and tail of pancreas

A

splenic artery

90
Q

normally expressed in fetal tissues and typically low in adults but some pancreatic neoplasms express

A

CEA

91
Q

whipple triad

A

symptoms of hypoglycemia
low plasma glucose
relief of symptoms with glucose administration

insulinoma

92
Q
  • peptic/duodenal ulcers
  • gastroesophageal reflux
  • diarrhea
A

gastrinoma

93
Q

4 Ds of glucagonoma

A
  • diabetes
  • dermatitis (necrolytic migratory erythema)
  • deep vein thrombosis
  • depression
94
Q

verner-morrison syndrome

A
  • watery diarrhea
  • hypokalemia
  • achlorhydria/hypochlorhydria

glucagonoma

95
Q
  • DM
  • diarrhea
  • steatorrhea
  • anemia
  • malabsorption
  • cholelithiasis
A

somatostatinoma

96
Q

what 2 NETs are closely associated with MEN1 mutations?

A

gastrinoma
insulinomas

GIR Test 3 (16 decks)

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