Liver, Pancreas, Biliary, Colon Cancer

Question 1

What is the definition of cancer?

Answer 1

mutations allowing for uncontrolled growth, sustained angiogenesis, tissue invasion & metastasis

Question 2

Describe the management of colon cancer.

Answer 2

• ** Incidence** - Approximately 150,000 new cases each year.
  
  • Anatomy
  • Risk factors- age > 60yrs, diet high in red or processed meats, family history, genetic predisposition
• Methods of Screening—stool blood test, endoscopy
• How/why do we stage colon cancer?
  
  • Staging determines treatment and prognosis
• Principles of treatment
  
  • Localized tumors get a local treatment (Surgery)
  • Regional tumors get a local and a systemic treatment (Surgery + Chemotherapy)
• Advanced tumor get a systemic therapy (Chemotherapy)

Question 3

Describe the management of pancreatic cancer.

Answer 3

• Incidence—Approximately 45,000 new cases each year.
• Anatomy
• Histology—Ductal adenocarcinoma is the most common
• Risk factors—age >60 yrs, smoking, chronic pancreatits, family history, genetic predisposition
• Common mutations—KRAS, p53, p16, DPC4
• Principle of treatment
  
  • Localized tumors get a local treatment (Surgery)
  • Regional and Advanced tumors get a systemic treatment (Chemotherapy)

Question 4

What are the major risk factors for CRC?

Answer 4

• ≥60 years of age
• Diet high in red or processed meats
• Have colorectal polyps or IBD
• Family history of CRC
• Personal history of breast cancer
• Genetics
  
  • Familial adenomatous polyposis (FAP)
  • Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome

Question 5

What are some important warning signs for CRC?

Answer 5

• Screening is important as early CRC often has no symptoms
• As the polyp grows, it can obstruct the wall of the intestine or bleed
• Warning signs:
  
  • Blood in stool or toilet after a BM
  • Unintentional weight loss
  • Dark or black-colored stools
  • New onset of diarrhea or constipation lasting more than a few days

Question 6

What is the histological classification of pancreatic cancer?

Answer 6

• Adenocarcinoma
  
  • ductal - 90-95%
  • acinar - 2%
• Neuroendocrine
  
  • (islet cell) tumor - 5%

Question 7

What is the common symptoms of pancreatic cancer?

Answer 7

• Abdominal pain or abdominal pain radiating to back
• Weight loss, anorexia
• Diarrhea, nausea/vomiting
• Jaundice
• New onset diabetes
• Depression

Question 8

What is the mechanism of gemcitabine?

Answer 8

• Pyrimidine analog functions as antimetabolite
• Reproductive block at G1/S interface
• Clinical response rate of 27% in advanced disease
• Improved pain control, performance status, and weight gain compared to 5-FU