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Gastrointestinal > Pancreatic CA > Flashcards

Pancreatic CA Flashcards

1
Q

Where does pancreatic cancer rank among the mortality of CA?

A

4th

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2
Q

Where does the pancreas sit in the abdomen?

A

Retroperitoneal space

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3
Q

Which part of the pancreas comprises the majority of the tissue (exo or endocrine)?

A

Exocrine

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4
Q

What are the stages T1-T4 of pancreatic tumors?

A 
T1 = less than 2 cm
T2 = greater than 2 cm
T3 = Invades into duodenum, bile duct major veins
T4 = invades large arteries, stomach, spleen
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5
Q

What type of tumors arise from the pancreas?

A

Adenocarcinomas

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6
Q

What is the histology of the adenoCA of the pancreas?

A

Well differentiated cuboidal cells with duct-like structures that contain mucin

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7
Q

What is the oncogene that is present in the majority of adenoCAs?

A

KRAS

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8
Q

What are the two oncogenes that are activated in many pancreatic cancers?

A

Kras and AKT2

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9
Q

What are the three tumor suppressor genes that are mutated in pancreatic cancers?

A

p16
p53
DPC4

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10
Q

What percent of pts with pancreatic ca have a family h/o it?

A

7-8%

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11
Q

What are the associated family genetic mutations that are associated with pancreatic CA?

A

Familial adenomatous polyposis

Peutz-Jegeh

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12
Q

What is the genetic mutation associated with peutz-jeghers syndrome

A

STK11

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13
Q

Pancreatic cancers are rare below what age?

A

45 yo

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14
Q

What are the diseases that predispose pts to

A

DM

Chronic pancreatitis

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15
Q

What are the chemical that predispose pts to pancreatic cancers?

A

beta-naphthylamine

Benzidine

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16
Q

What is the diet that can predispose to pancreatic cancer?

A

High in fats and meats

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17
Q

What ethnicity has a higher rate of pancreatic cancer?

A

Blacks

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18
Q

What is the usual presentation of pancreatic cancer?

A

Jaundice
weight loss
Abdominal pain

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19
Q

New onset DM I in an older pt is concerning for what?

A

Pancreatic tumor that obliterate the beta cells

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20
Q

What is the cause of hyperbilirubinemia in pts with pancreatic cancer?

A

mass effect on common bile duct

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21
Q

Tumors of which part of the pancreas usually present with pain?

A

Tail or body

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22
Q

How do you diagnose pancreatic tumors?

A

Imaging (CT especially)

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23
Q

Why are pancreatic cancers particularly deadly?

A

Not symptomatic until late

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24
Q

What is the best test for determining the resectability of a pancreatic cancer? What determines resectability?

A

CT

  • No extrapancreatic disease
  • No extension to the celiac axis or SMA
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25
Q

What happens to the common bile duct and pancreatic duct in pancreatic tumors?

A

Dilation

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26
Q

What can ERCPs be utilized for?

A

Detecting small tumors not visualized on CT

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27
Q

What is the radiological sign of a pancreatic CA in the head of the pancreas?

A

Double duct sign

dilation of the pancreatic and bile duct

28
Q

What is the role of an endoscopic ultrasound for pancreatic cancers?

A

Aids in diagnosis and characterization of lesions, as well as allows for biopsies

29
Q

What are the three common met sites for pancreatic cancer?

A

Liver
Peritoneum
Lungs

30
Q

What level of bilirubin causes jaundice?

A

Greater than 2 mg/dL

31
Q

What is stage I pancreatic cancer?

A

Isolated lesion

32
Q

What is stage II pancreatic cancer?

A

Invasion of the bowel or lymph node

33
Q

What is stage III pancreatic cancer?

A

Very close to a vascular structure

34
Q

What is the main markers of pancreatic cancer?

35
Q

What are the ssx of pancreatic cancer?

A

back pain
Weight loss
Jaundice

36
Q

Back pain with pancreatic cancer usually suggests what?

A

invasion of local structures

37
Q

Decrease in CA 19-9 correlates with what?

A

Survival rates increase

38
Q

What is the value of CA 19-9?

A

Following pts with CA

Differentiating between pancreatic CA and pancreatitis

39
Q

What are the main chronic symptoms with pancreatic cancer? (4)

A

Pain
Weight loss
Pruritus
Need for pancreatic enzyme replacement

40
Q

What is the standard surgical procedure for pancreatic cancer? What is done in this?

A

Whipple—-cholecystectomy + duodenectomy + pancreatectomy (head only)

41
Q

What is the prognosis for pts who undergo the Whipple procedure for pancreatic cancer?

A

only live for about 15 months longer

42
Q

What are the drugs that are used for pancreatic cancer?

A

5FU (maybe)

Gemcitabine

43
Q

What is the drug that has shown some better prognosis when added to Gemcitabine for pancreatic cancer?

44
Q

Why is it hard for chemotherapeutic agents to attack pancreatic cancer?

A

Dense and highly fibrotic tissue

45
Q

What is the rare pancreatic CA type?

A

Cystic neoplasm

46
Q

What are the ssx of cystic neoplasm?

A

Malabsorption (lack of enzymes)
Obstructive jaundice
Recurrent pancreatitis

47
Q

What is the chemical that is produce by the majority of cystic neoplasms of the pancreas?

48
Q

Where are cystic tumors of the pancreas usually found?

A

body or tail

49
Q

How do you diagnose cystic pancreatic CA?

A

Abdominal CT
EUS
Biopsy

50
Q

What are the tumors that arise from the islets of langerhans?

A

Pancreatic neuroendocrine tumors

51
Q

What is the origin of endocrine tumors of the pancreas? What are the kinds (5)?

A

Neuroendocrine cells

  • insulinoma
  • gastrinoma
  • Glucagonoma
  • VIP secreting tumor
  • Somatostatinoma
52
Q

What is the most common endocrine tumor of the pancreas? Ssx?

A

Insulinoma

Hypoglycemia ssx

53
Q

What is whipple’s triad?

A

Signs of insulinoma:

  1. symptoms of hypoglycemia during fasting or exercise
  2. Serum glucose less than 50 mg/dL during ssx
  3. Relief of symptoms with glucose
54
Q

What are the two tests that are useful for diagnosing insulinomas (besides BG and insulin levels)?

A

Anti-Insulin antibodies

C-peptide levels

55
Q

What is the best way to diagnose a insulinoma?

A

us and palpation

56
Q

What are the ssx of zollinger-ellison syndrome?

A

Recurrent ulcerations secondary to hypergastrinemia

57
Q

What is the treatment for zollinger-ellison syndrome?

A

PPIs

Surgical resection

58
Q

What are the vertices of the gastrinoma triangle?

A

Junction of:

  • head and body of pancreas
  • 2nd and 3rd part of the duodenum
  • cystic and bile duct
59
Q

True or false: pts with peritoneal intrusion of pancreatic CA are considered to have metastatic disease

60
Q

Why is it better to have CA in the head of the pancreas as opposed to the body or tail?

A

More likely to develop ssx early

61
Q

True or false: most pancreatic cancers are too far advanced by the time of diagnosis to be resected

62
Q

When is chemoradiation indicated for Pancreatic cancer?

A

Palliation of pain

63
Q

What is the role of the hedgehog pathway in pancreatic cancer?

A

Important in stromal cell proliferation

64
Q

What is the MOA of ruxolitinib?

A

JAK2 inhibitor used in the treatment of some pancreatic cancers

65
Q

In whom are mucinous cystadenomas or the pancreas more common? Where are these located? How often do these lead to invasive cancer?

A
  • Middle aged women
  • Usually body or tail
  • Frequent progression to invasive CA
66
Q

In whom are intraductal papillary mucinous neoplasms of the pancreas more common? Ssx? Treatment?

A

Men over 60 yo
Recurrent pancreatitis
Surgical resection

67
Q

What is the treatment for Zollinger-Ellison?

A

PPIs

Surgic resection

Gastrointestinal (42 decks)

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