Pancreas

Question 1

What are the parts of the pancreas?

Answer 1

The pancreas can be divided into the head, uncinate process, neck, body, and tail.

Question 2

What are the functions of the pancreas?

Answer 2

The pancreas has both an endocrine (insulin, glucagon) and exocrine (digestive enzymes) function.

Question 3

How does the pancreas deliver its hormones and enzymes?

Answer 3

It delivers its endocrine hormones into the circulatory system and its enzymes into the small intestines.

Question 4

What is the vertebral location of the pancreas?

Answer 4

The pancreas is retroperitoneal and located at the level of T12-L2.

Question 5

What are the three anatomic regions of the pancreas?

Answer 5

The pancreas is divided into the head, body, and tail.

Question 6

Where is the head of the pancreas located?

Answer 6

The head of the pancreas is located in the C-loop of the duodenum.

Question 7

What structures are in direct contact with the pancreas?

Answer 7

The pancreas is in direct contact with the duodenum, jejunum, stomach, IVC, spleen, and kidney.

Question 8

Why are pancreatic tumors often unresectable at diagnosis?

Answer 8

Tumors of the pancreas commonly invade surrounding structures.

Question 9

What percentage of all cancers does pancreatic cancer represent?

Answer 9

Approximately 2% of all cancers.

Question 10

What is the rank of pancreatic cancer as a cause of cancer deaths in the US?

Answer 10

Fourth leading cause of cancer deaths in the US.

Question 11

Is pancreatic cancer more common in males or females?

Answer 11

More common in males.

Question 12

Which racial group has a higher incidence of pancreatic cancer?

Answer 12

More common in African Americans.

Question 13

What age group is most affected by pancreatic cancer?

Answer 13

50-80 years old.

Question 14

How does age affect the incidence of pancreatic cancer?

Answer 14

Incidence increases with age.

Question 15

What is the risk factor associated with smoking and pancreatic cancer?

Answer 15

Smokers have a two times higher risk of development of pancreatic cancer.

Question 16

What are the signs and symptoms of pancreatic cancer?

Answer 16

• Weight loss**
• Anorexia**
• Abdominal and/or Back Pain**
• Jaundice**
• Loss of appetite
• Diabetes
• Itching
• Change in bowel movement
• Fever and Shivering
• Pancreatitis
• Fibrosis

** - most common

Question 17

What is the most common symptom of pancreatic cancer?

Answer 17

Weight loss

** - most common

Question 18

What can the tumor’s obstruction of the biliary system result in?

Answer 18

An enlarged pancreas, gallbladder, or liver.

Question 19

What is the most valuable diagnostic test for pancreatic cancer?

Answer 19

CT scan of the abdomen.

This scan provides a complete view of the abdominal structures most likely involved with the tumor.

Question 20

What other imaging tests are used in the diagnostic workup for pancreatic cancer?

Answer 20

MRI and PET.

Question 21

What are the tumor markers associated with pancreatic cancer?

Answer 21

CA 19-9 and Carcinoembryonic antigen (CEA).

Question 22

What procedure is done after a positive first CT scan?

Answer 22

CT guided fine needle biopsy.

Question 23

What type of cancer constitutes 80% of pancreatic cancer cases?

Answer 23

Adenocarcinomas

Question 24

What are the other types of pancreatic tumors aside from adenocarcinomas?

Answer 24

Islet cell tumors, Acinar cell carcinomas, Cystoadenocarcinomas

Question 25

Where does pancreatic cancer most commonly occur?

Answer 25

In the head of the pancreas

Question 26

What staging system is used for pancreatic cancer?

Answer 26

TNM

Question 27

What is the common state of tumors at the time of diagnosis for pancreatic cancer?

Answer 27

Most tumors have advanced local and/or metastatic disease at the time of diagnosis.

Question 28

What are common sites of lymph node involvement for pancreatic cancer?

Answer 28

Typical nodes include the peripancreatic, hepatic, and paraaortic nodes.

Question 29

What are the common routes of spread for pancreatic cancer?

Answer 29

Common routes include direct extension, lymphatics, and hematogenous spread.

Question 30

What organs are involved in direct extension of pancreatic cancer?

Answer 30

Bile duct system, duodenum, stomach, and spleen.

Question 31

What are common sites of hematogenous spread for pancreatic cancer?

Answer 31

Liver, lung, and pleura.

Question 32

What is the treatment of choice for pancreatic cancer?

Answer 32

Surgery is the treatment of choice (TOC) for pancreatic cancer. ## Footnote Most tumors are unresectable though.

Question 33

What is the most common potentially curative surgical procedure for pancreatic cancer?

Answer 33

The most common potentially curative surgical procedure is a pancreaticoduodenectomy (Whipple). ## Footnote This procedure involves the removal of the head of the pancreas, entire duodenum, distal stomach, gallbladder, and common bile duct.

Question 34

What are the preferred treatments for borderline resectable and locally advanced unresectable pancreatic cancers?

Answer 34

Radiation therapy and chemotherapy are considered the preferred treatments.

Question 35

How does the outcome of radiation therapy compare to Whipple's procedure for pancreatic cancer?

Answer 35

Radiation therapy outcome is like that of Whipple's procedure.

Question 36

What is the typical treatment field arrangement for radiation therapy for pancreatic cancers?

Answer 36

The typical treatment field arrangement used is VMAT with two to three full 360-degree arcs.

Question 37

What is the dose range delivered in radiation therapy for pancreatic cancer?

Answer 37

A dose of 45 to 55 Gy is delivered in 1.8 Gray fractions with a reduction in the field volume after 45 Gray.

Question 38

What other treatments can be used for pancreatic cancer besides traditional radiation therapy?

Answer 38

Can also be treated with SRS or Proton therapy.

Question 39

What imaging techniques are necessary for simulation?

Answer 39

CT/MRI Fusion with renal contrast and barium.

Question 40

What type of device is made for SBRT simulation?

Answer 40

A full-body vacuum device for immobilization, which might include abdominal compression.

Question 41

What should the simulation include to assess respiratory motion?

Answer 41

A 4D CT scan.

Question 42

What are the organs at risk during radiation therapy for pancreatic cancers?

Answer 42

The organs at risk include the spinal cord, kidney, small intestine, liver, and stomach.

Question 43

What are the acute side effects of radiation when treated for pancreatic cancer?

Answer 43

The acute side effects include nausea and vomiting, leukopenia, thrombocytopenia, diarrhea, and stomatitis. ## Footnote Antiemetics can be given to mitigate nausea and vomiting.

Question 44

What is a chronic side effect of radiation treatment for pancreatic cancer?

Answer 44

A chronic side effect can be renal failure, which is rare but suggests that the kidney possibly received a higher dose of radiation.