Background

Question 1

Appx how many pancreatic adenocarcinoma (PCA) pts are diagnosed per yr in the United States?

Answer 1

As of 2016, the incidence of PCA is 53,670 cases/yr in the United States, with 43,090 deaths. Its incidence is higher in developed countries.

Question 2

Where does PCA rank in cancer incidence in the United States? Cancer mortality?

Answer 2

As of 2016, PCA is the 12th most common cancer Dx but the 4th most common cause of cancer death in the United States.

Question 3

Is there a racial or sex predilection for PCA?

Answer 3

Yes. African Americans are more commonly affected than Caucasians; however, the incidence is similar among males and females.

Question 4

In what decades of life does PCA incidence peak?

Answer 4

The peak age of PCA is in the 6th–7th decades of life.

Question 5

What are 3 environmental exposures associated with PCA?

Answer 5

Most common environmental risk factors for PCA:

1. Tobacco smoking
2. 2-naphthylamine
3. Benzidine

Question 6

What % of PCA is familial?

Answer 6

∼10% of PCA is familial.

Question 7

What 2 genetic mutations have most frequently been associated with familial PCA?

Answer 7

p16 and BRCA2 are the 2 most common familial associated genetic changes found in PCA.

Question 8

Is chronic pancreatitis associated with increased risk of PCA?

Answer 8

No. Chronic pancreatitis is not associated with risk of PCA. Historically, there appeared to be an association, but this can be explained by confounding factors.

Question 9

Appx at what vertebral bodies are the pancreas, celiac axis, and superior mesenteric artery (SMA) located?

Answer 9

Pancreas: L1–2

Celiac axis: T12

SMA: L1

Question 10

What % of PCA arise in the head, body, and tail of the pancreas?

Answer 10

Common PCA sites are 75% in the head, 15% in the body, and 10% in the tail.

Question 11

What is the distribution of local, regional, and metastatic Dz at Dx?

Answer 11

10% of PCA pts have local Dz at Dx.

25% of PCA pts have regional node+ Dz at Dx.

50% of PCA pts have DM at Dx.

Question 12

For PCA, what are the 3 most common sites of DM?

Answer 12

Common sites of DM for PCA include the liver, peritoneum, and lungs.

Question 13

Is there a role for screening in PCA?

Answer 13

No. There is no current role for PCA screening. There are studies evaluating the role of screening 1st-degree relatives of PCA with EUS, but this is still experimental.

Question 14

What % of pancreatic tumors are from the exocrine pancreas?

Answer 14

95% of PCA are from the exocrine pancreas.

Question 15

What are the 4 most common pathologic subtypes of exocrine pancreatic tumors?

Answer 15

Most common subtypes of exocrine pancreatic tumors:

1. Ductal adenocarcinoma (80%)
2. Mucinous cystadenocarcinoma
3. Acinar cell carcinoma
4. Adenosquamous carcinoma

Question 16

What are the most common oncogenes in PCA?

Answer 16

K-ras oncogene is present in >95% of PCA.

p16 mutations are seen in >90% of PCA.

p53 mutations occur in 55%–75% of PCA.

DPC4 mutations occur in ∼50% of PCA.

Question 17

What are the most common presenting signs & Sx of PCA?

Answer 17

Common presenting signs & Sx of PCA are pancreatic/biliary duct obstruction, jaundice, and abdominal pain.

Question 18

What Dz is commonly diagnosed 1–2 yrs prior to a PCA Dx?

Answer 18

60%–80% of PCA pts are diagnosed with diabetes 1–2 yrs prior to Dx. However, only a small proportion of diabetic pts develop PCA.

Question 19

Periampullary cancers refer to tumors arising from what 4 structures?

Answer 19

Periampullary tumors are those arising from the ampulla of Vater, common bile duct (CBD), head of the pancreas, and adjacent duodenum.