Carcinoma of the pancreas Flashcards
What is the most common pancreatic neoplasm?
90% are ductal adenocarcinomas
What are the major risk factors for pancreatic cancer?
Cigarette smoking (2-3x) Chronic pancreatitis (10-15x) Diabetes Hereditary pancreatitis (50x)
Why is pancreatic cancer so lethal?
- Early diagnosis is rare. No screening methods, of diagnostic tumor marker
What determines the resectability of the pancreas?
Extension into portal vein/SMA/Nerves. Local involvement of spleen, adrenals, vertebral column, colon stomach
–>Perineural invasion is especially common in pancreatic carcinoma
What is a PanIN tumor?
Non-invasive epithelial neoplasm arising in the pancreatic ducts. Usually with varying amounts of mucin and cytologic changes.
It’s a carcinoma in situ with high rate of progression
What size ducts do PanINs show up in?
ducts <5 mm in diameter
What tumor markers are seen in PanIN-1?
K-ras mutation
PanIN-2?
p16 mutation
PanIN-3?
p53 and BRCA2 mutations. This is why there are MULTIPLE mutations at the time of diagnosis
What might give you a false positive for pancreatic cancer?
Cystic masses are often benign
Pancreatitis (esp autoimmune) can mimic pancreatic cancer
What are three main types of benign excorine tumors?
- serous cystadenoma
- Mucinous cystadenoma
- Intraductal papillary-mucinous adenoma
What type of neoplasm has a good prognosis when resected?
Intraductal papillary-mucinous neoplasm (IPMN)
Mucinous cystadenoma
What kind of neoplasm would you see in a child?
pancreatoblastoma. 5 year survival of 60%
What type of pancreatic cancer would you see in a teenage or young woman?
pseudopapillary neoplasm: excision=cure usually
What types of patients will have mucinous cystic neoplasms of the pancreas?
middle aged women. Very rare in men. 10-20% are malignant.
