Lesson 3B (Part 1) Flashcards
Types of neoplasms of the pancreas? (4)
- Periampullary
- Cystic
- simple
- serous cystic
- mucinous intraductal - Pseudopapillary
- Endocrine, lipoma and mets
What are examples of periampullary neoplasms? (4)
- Pancreatic ductal adenocarcinoma
- 66% - Ampullary carcinoma
- 15-25% - Duodenal carcinoma
- 10% - Distal cholangiocarcinoma
- 10%
What is the survival rate like for periampullary neoplasms?
Poor
- difficult to resect
What is the most common presentation of periampullary neoplasms?
Jaundice
How is periampullary neoplasms managed?
With Whipples Procedure
- pancreaticoduodenectomy
- depending on stage at time of diagnosis ***
What is the most common primary pancreatic neoplasm?
Pancreatic ductal adenocarcinoma
What is the 4th most common cause of cancer death?
Pancreatic ductal adenocarcinoma
What is the percent of pancreatic ductal adenocarcinoma malignancies?
85-90%
What can detect advanced diseases? (2)
- US
2. CT
What is the cure for pancreatic ductal adenocarcinoma?
Its rare
- 5 yr survival rate is 2-5%
What are the risk factors for ductal adenocarcinoma? (8)
- Slight male predominence
- 60-80 yrs of age
- Smoking
- Obesity
- Chronic pancreatitis
- Diabetes
- Cirrhosis
- Family history of pancreatic CA
What are classic symptoms of ductal adenocarcinoma? (3)
- Jaundice
- Pain
- Weight loss
What is ductal adenocarcinoma associated with? (5)
- Increased bilirubin and ALP
- Urine is dark
- Stools are pale
- Pruritis
- itchy and uncomfortable sensation of the skin
What is the % of cancers that originate from the head of the pancreas?
60-70%
What is the % of cancers that originate from the body and tail of the pancreas?
25-35%
What are sonographic signs of ductal/periampullar adenocarcinoma?
- Double- duct sign
- CBD and pancreatic duct dilation - Solid mass in the pancreatic head region
- Variable echotexture
- can lead to Courvoisier GB
Courvoisier GB
Enlarged palpable gallbladder in a patient with carcinoma of the head of the pancreas
- dilated CBD
What is Courvoisier GB associated with?
Jaundice
- due to obstruction of the CBD (mass is pushing on it)
What needs to be determined for the treatment/prognosis of duct adenocarcinomas?
If patient can have tumour removed aka resected
When is a tumour unresectable? (4)
- Tumor larger than 2 cm
- Extracapsular extension
- Lymphadenopathy
- Metastatic disease
How do you determine the chance for resection for ductal adenocarcinoma?
Vascular invasion
What are critical vessels that can have a relationship of a tumour mass that is associated with ductal adenocarcinoma? (5)
- MPV
- SMV
- SV
- LRV
- IVC
What are useful modalities for staging ductal adenocarcinomas? (3)
- CT
- MRI
- Endoscopy
Whipples procedure
Is an operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct
What is not being invaded on during the whipples prodceude? (4)
- SMA
- IVC
- AO
- CA
What i the result of the whipples procedure?
Surgical anastomosis of the CHD and remaining pancreas and stomach to the jejunem
What happens after the whipples procedure?
Hepatic function decreases
What are symptoms of decrease in hepatic function? (4)
- Fatigue
- Anorexia
- Bruising due to loss of clotting factors
- Increased mortality rate in the centers that do not do a lot of these procedures
What kind of surgery is the whipples procedure?
Long and complex
- experienced surgeons have the best outcome for their patients
