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Gastrointestinal System > EXAM #3: PANCREATIC CANCER > Flashcards

EXAM #3: PANCREATIC CANCER Flashcards

1
Q

Where is pancreatic cancer more prevalent geographically?

A

In well developed countries

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2
Q

What is the mortality associated with pancreatic cancer in the US?

A

4th leading cause of cancer mortality in the US

*Note that is also has the poorest prognosis of all cancers

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3
Q

Where is the pancreas located?

A

Retroperitoneal in close proximity to the duodenum

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4
Q

What are the two types of cells in the exocrine pancreas?

A

Acinar cells and duct cells

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5
Q

What is the most common type of pancreatic cancer?

A

Adenocarcinoma arising from the exocrine pancreas (90%)

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6
Q

How would you describe the histopathology of an adenocarcinoma?

A
  • Well differentiated cuboidal cells

- Duct-like structures that contain mucin

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7
Q

What oncogene is highly associated with pancreatic carcinoma?

A

K-ras (90%)

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8
Q

What diseases are associated with pancreatic adenocarcinoma?

A
  • FAP
  • Peutz-Jeghers
  • Von Hippel-Lindau
  • MEN1
  • HNPCC
  • BRCA
  • Familial atypical multiple mole melanoma (FAMMM)
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9
Q

What are the non-genetic risk factors for pancreatic cancer?

A
  • Age older than 45
  • Chronic pancreatitis
  • Smoking
  • DM
  • Diet high in fat/meat
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10
Q

What chemical exposures are risk factors for pancreatic cancer?

A

B-naphthylamine

Benzidine

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11
Q

What surgical history is a risk factor for pancreatic cancer?

A

Partial gastrectomy

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12
Q

How does pancreatic cancer typically present?

A

1) Abdominal pain
2) Weight loss
3) Jaundice
4) Steatorrhea
5) Pruritus

Elderly patient that develops glucose intolerance

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13
Q

How is pancreatic cancer diagnosed?

A

1) Spiral CT with IV contrast
- Determines mets and resectability
2) Confirm with biopsy

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14
Q

What are the determinants of resectablilty in pancreatic cancer?

A

1) No extrapancreatic disease

2) No direct tumor extension into the celiac axis and SMA

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15
Q

What is the utility of ERCP in pancreatic cancer?

A

1) Detection of small tumors not seen on CT

2) Palliation of biliary obstruction

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16
Q

What sign on imaging is pathognomonic for pancreatic adenocarcinoma?

A

“Double-duct” sign

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17
Q

What is EUS?

A

Endoscopic US

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18
Q

What is the utility of EUS in pancreatic cancer?

A

1) Aid in diagnosis and characterization of lesion
2) Biopsy

EUS biopsy is associated with LESS peritoneal seeding compared to percutaneous CT guided biopsy

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19
Q

What are the most common sites of metastasis for pancreatic adenocarcinoma?

A
  • Lung
  • Liver
  • Peritoneum
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20
Q

What stage are patients in when they start to experience symptoms of pancreatic cancer?

A

T3= local invasion of bowel, bile duct, and major vessels

21
Q

What is the tumor marker for pancreatic cancer?

A

CA19-9

22
Q

Localization of pnacreatic cancer to which region of the pancreas is associated with earlier diagnosis?

A

Head of the pancreas

23
Q

What is associated with decreased serial CA 19-9 levels following treatment?

A

Increased survival

24
Q

What is the primary goal of treatment in pancreatic cancer?

A

Symptom control

  • Pain
  • Weight loss
  • Pruritus
25
Q

How is pain controlled in pancreatic cancer?

A

1) Opiates

2) Celiac plexus neurolysis

26
Q

How is weight loss managed?

A

Replacement of pancreatic enzymes

27
Q

How is pruritus managed?

A

Anti-histamines
SSRI
Bile-acid binding resins

28
Q

What procedure is used to resect the pancreas?

A

“Whipple procedure” or pancreaticoduodenectomy

Note that b/c of late stage diagnosis, 80-85% are NOT amenable to resection

29
Q

How is pancreatic cancer medically managed?

A

Chemotherapy

1) 5-FU
2) Gemcitabine

*Note that 5-FU + Radiation was just as good as 5-FU alone

30
Q

Generally speaking, what is the impact of intervention in the prognosis for pancreatic cancer?

A

Minimal–surgery buys more months than chemo, but both are only getting the patient more MONTHS

31
Q

How common are cystic neoplasms?

A

Rare

32
Q

What are the symptoms of a cystic neoplasm?

A
  • Bloating
  • Weight loss
  • Obstructive jaundice
33
Q

What is the most common type of cystic neoplasm?

A

Mucinous cystadenomas and Cystadenocarcinomas

34
Q

What are the clinical features of Mucinous cystadenomas and Cystadenocarcinomas?

A
  • More common in middle aged women

- Usually in body or tail of pancreas

35
Q

What is intraductal papillary mucinous neoplasm?

A

Pancreatic precursor tumor

36
Q

What are the clinical features of Intraductal papillary mucinous neoplasms?

A
  • Men 60+

- Recurrent pancreatitis from mucin obstructing the pancreatic duct

37
Q

How are Cystic Neoplasms worked up?

A

1) Abdominal CT
2) EUS
3) Biopsy

38
Q

What is the treatment for symptomatic, malignant or potentially malignant cystic neoplasms?

A

Surgical resection

39
Q

List the various types of endocrine tumors.

A
  • Insulinoma
  • Gastrinoma
  • Glucagonoma
  • VIPoma
  • Somatostatinoma
40
Q

What is the most common type of endocrine tumor?

A

Insulinoma

41
Q

What type of symptoms are seen with Insulinomas?

A

Generally, hypoglycemia in younger individuals

42
Q

What is Whipple’s Triad in Insulinomas?

A

1) Hypoglycemic sx.
2) Serum glucose less than 50 mg/dL
3) Relief with glucose adminstration

43
Q

How is an Insulinoma diagnosed?

A
  • 72 hour fast with insulin measurement

- Elevated c-peptide and proinsulin are confirmatory

44
Q

What is the gold standard for imaging an insulinoma?

A

Intraoperative US and palpation

45
Q

What is the typical presentation for Gastrinomas?

A
  • Abdominal pain
  • PUD
  • GERD
  • Diarrhea
46
Q

How are Gastrinomas diagnosed?

A

1) Elevated serum gastrin

2) Secretin stimulation test

47
Q

Where is the Gastrinoma triangle?

A

1) superior= cystic and common bile ducts
2) inferior= second and third parts of duodenum
3) medial= neck and body of the pancreas

48
Q

How are Gastrinomas treated?

A

PPIs and surgical resection

Gastrointestinal System (42 decks)

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