Pancreatic AC Flashcards
Pancreatic AC is of an ___ source - the ___ of the pancreatic ducts.
exocrine
epithelium
The different types of exocrine pancreatic cancer are: PDAC= \_\_\_ (80%) IPMN= \_\_\_ \_\_\_ \_\_\_
pancreatic ductal AC
intraductal papillary mucinous neoplasm
acinar cells Ca
islet cells
Islet cell pancreatic cancer is responsible for: (5) \_\_\_ \_\_\_ \_\_\_ \_\_\_ \_\_\_
insulinoma gastrinoma VIPoma glucagonoma somatostatinoma
Pancreatic AC is more common in ___ ___ with mean age of ___
black
men
72
Risk factors include: (8) \_\_\_ (X3) \_\_\_ age \_\_ and \_\_ chronic \_\_\_ link to \_\_ and \_\_\_ high \_\_ diet past history of \_\_
smoking old obesity & DM pancreatitis CF & ataxia-telangiectasia fat gastrectomy
What are the main genetic syndromes associated with pancreatic cancer? (6) \_\_\_ (40%) \_\_\_ X132 \_\_ /\_\_ X4, X8 \_\_\_ X10 \_\_\_ \_\_\_ X30
familial pancreatitis Peutz Jeghers FAP/HNPCC BRCA 2 Li Fraumeni CF
70% of pancreatic tumors are found at the __ of the pancreas, 30% at the __ and ___
head
body
tail
What are the most common symptoms of pancreatic cancer in the head of the pancreas?
___ 75%
___ loss 50%
___ pain radiating to the back 40%
__/__/__
___ sign (gallbladder is palpable but not sensitive)
jaundice weight epigastric nausea/vomiting/pruritus Courvoisier sign
___ syndrome is the most common sign for tumors at the __ of the pancreas
Trousseau (vessel inflammation due to blood clot)
head
The most sensitive marker for pancreatic cancer is CA __ with sensitivity and specificity of ___%
CA 19-9
80
Pancreatic cancer diagnosis is made primarily with ___. Now days ___ is becoming more prominent
tri phase CT
PET CT
EUS with FNA is indicated before starting ___ (eg __) therapy
chemo
neoadjuvant
Pancreatic cancer staging (tumor):
T1- __ to the pancreas, __ cm
T3- __ to the pancreas, but does not involve important __ (may involve __)
T4- __ to the pancreas, involve important ___. Is considered to be ___
limited 2 unlimited arteries veins unlimited arteries inoperable
Pancreatic cancer staging (nodes/metastasis):
N0- ___ nodes
N1- ___ nodes
M0- __
M1- __ (most commonly to the __ and __)
no yes no yes liver lungs
What are the inoperable pancreatic tumors according to staging?
T_=stage_=involvement of main __
M_=stage_=__
T4=stage3=arteries
M1=stage4=metastasis
What are the main arteries to notice when talking about pancreatic cancer? (2)
SMA
celiac
What are the 3 classes of pancreatic tumors when considering surgery?
definitely operable
borderline
definitely inoperable
Definitely operable pancreatic tumors are tumors found only in the ___, without any important __ involvement, and a fatty layer surrounding the ___
pancreas
venous
arteries
What are the main veins to notice when talking about pancreatic cancer? (2)
SMV
portal vein
Inoperable pancreatic tumors are stage -, __, positive __ outside the field of operation, involvement of main __ vessels
3-4
ascites
lymph nodes
blood (beside the splenic)
Only ___% of pancreatic cancer cases are considered __
20
operable
When the pancreatic tumor is found in the ___ of the pancreas, the go to surgery is __
head
Whipple
Whipple has 3 stages: dissecting the __ of the pancreas together with the (4). Followed by removing the __, and finally performing ___.
head CBD gallbladder duodenum antrum lymph nodes reconstruction
What does Whipple reconstruction involves?
pancreatojejunostomy
hepaticojejunostomy
gastrojejunostomy
What are the possible p/o Whipple risks (4) delayed gastric \_\_\_ 18% pancreatic \_\_\_/\_\_\_leakage \_\_\_/abdominal \_\_ pancreatic \_\_\_
delayed gastric emptying
pancreatic fistulas/anastomosis leakage
SSI/abdominal abscess
pancreatic insufficiency
The classical treatment chemotherapy is ___ with ___ protocol (4) __/__
neoadjuvant
FOLFRINOX
5fu/ oxaliplatin/ irinotecan/ leucovorin
