Biliary and Pancreatic Cancer Flashcards
Biggest risk factor for developing gallbladder cancer.
Gallstone disease (80% of GB cancer patients have gallstones)
Which microbe adds risk to GB cancer?
Salmonella typhi
Most common malignant tumors found in GB.
Adenocarcinoma
What is a Krukenberg tumor?
A gallbladder adenocarcinoma that spreads into the peritoneum.
Main tumor marker that is elevated in GB cancer.
CA19-9
2 things often elevated in the serum with GB cancer.
- ALP
2. Bilirubin
Treatment for gallbladder cancer.
Tx: cholecystectomy, right hepatic lobectomy, or trisegmentectomy (removal of the true right lobe of the liver + most or all of the medial segment of the left lobe)
Microbe responsible for most bile duct cancers esp. in southeast Asia.
Liver Flukes
2 conditions associated with bile duct cancer.
- Primary Sclerosing cholangitis
- Ulcerative Colitis
(UC is not directly related but usually UC patients are checked for PSC which IS directly related)
How does a Klatskin Tumor present?
Painless jaundice
-it’s a cholangiocarcinoma at the junction of the left and right hepatic ducts
What serum bilirubin levels indicate bile duct cancer until it’s ruled out?
> 12 mg/dL
if painless jaundice occurs and levels are <8mg/dL then it is most likely a stone disease
Treatment for Intrahepatic or Klatskin tumor.
Resection, hepatojejunostomy
Treatment for mid-bile duct tumor
- resection
- cholecystectomy
- regional lymphadenectomy
- hepatojejunostomy
Treatment for distal bile duct tumor
Whipple Procedure
Most common site and presentation of Ductal Adenocarcinoma of the pancreas.
Head of the pancreas
-presents as jaundice due to pancreatic duct and bile duct obstruction
What is the Courvoisier Sign?
Palpable gallbladder in ductal pancreatic cancer involving the head of the pancreas.
What is a difference when using CT for diagnosis between adenomas and adenocarcinomas in the pancreas.
Benign adenomas calcify but malignant adenocarcinomas do not.
Tumor marker that rises in the serum and can indicate pancreatic cancer.
CA19-9
What is the double duct sign?
Both pancreatic and bile ducts are dilated. Viewed with ERCP and may indicate pancreatic cancer.
Best method to stage pancreatic cancer.
Ultrasound
Most effective treatment of pancreatic cancer.
Whipple Procedure or pancreatectomy
Most common pancreatic endocrine neoplasm.
Insulinoma
Dx of Insulinoma
Hypoglycemia + elevated insulin levels + pancreatic mass
insulin/glucose > 0.3
What is Verner-Morrison syndrome?
Fasting large-volume diarrhea, hypokalemia, hypochlorohydria due to VIPoma of the pancreas.
Major condition associated with Glucagonomas and Dx.
Necrolytic Migrating Erythema (dermatitis)
Dx: serum glucagon > 1000pg/ml + pancreatic mass
Triad seen in a somatostatinoma.
Gallstones
Diabetes Mellitus
Diarrhea (steatorrhea due to inhibition of gallbladder contraction)
Main complication of GRFoma.
Acromegaly
Other tumor associated with GRFomas.
Gastrinoma (ZE syndrome)
Tx for endocrine tumors.
Somatostatin (for all but somatostatinomas)
Surgical resection
Treatment for ampullary carcinoma.
Whipple Procedure
