pancreatic cancer

Question 1

what are the four tissues that adenocarcinoma can arise from in the pancreas ?

Answer 1

head of pancreas
distal bile duct
ampulla of vater
periampullary duodenum

Question 2

which tissue origin gives the best prognosis ?

Answer 2

ampulla

Question 3

what is the typical presentation of pancreatic carcinoma ?

Answer 3

jaundice
pain
weight loss 
anorexia 
nausea with or without vomiting 
abdominal and/or back pain

Question 4

when can pancreatic carcinoma not produce jaundice ?

Answer 4

when theres a carcinoma of the distal pancreas they dont produce jaundice until they metastasize so they present late

Question 5

what are the physical findings in the early stage of the disease ?

Answer 5

palpable gallbladder (Courvoisier’s sign)

Question 6

what are the physical findings in the late stages of the disease ?

Answer 6

cachexia 
ascites 
left supraclavicular adenopathy 
palpable abdominal mass 
migrating thrombophlebitis

Question 7

what is the normal bilirubin level ?

Answer 7

less thann 1

Question 8

what are the lab findings in pancreatic carcinomas ?

Answer 8

elevated serum bilirubin

elevated alkaline phosphatase

Question 9

what is the most specific tumor marker in pancreatic carcinomas ?

Answer 9

CA19-9

Question 10

which vessel is the head of the pancreas related to ?

Answer 10

superior mesenteric vessels

Question 11

which vessel is more likely to be invaded when it comes to cancer head of pancreas ?

Answer 11

superior mesenteric vein , the artery is less likely to be invaded

Question 12

what type of imaging modalities can we use to diagnose pancreatic cancers ?

Answer 12

PET CT

CT

Question 13

how do we take a biopsy of the pancreas ?

Answer 13

trans-duodenal guided ultrasound

Question 14

what are the clinical criteria for pancreatic resection ?

Answer 14

intrapancreatic carcinoma 
local invasion n
vascular invasion 
extrapancreatic nerve plexus invasion n
peritoneal metastasis 
liver metastasis

Question 15

what is whipple’s procedure ?

Answer 15

pancreaticodudonectomy

Question 16

when can we perform a total pancreatectomy ?

Answer 16

inn certain diseases such as mucinous adenocarcinoma

Question 17

what is kocherization of the duodenum ?

Answer 17

maneuver to mobilize the duodenum before performing other procedures locally or before incising the duodenum

Question 18

what is the problem with a complete pancreatectomy ?

Answer 18

incurable diabetes

Question 19

what other procedures can performed in cases of cancer head of pancreas?

Answer 19

pancreatico-jejunostomy

pancreatico-gastrotomy

Question 20

what molecular targeted therapy can nbe used inn pancreatic cancers ?

Answer 20

bevacizumab

cetuximab

Question 21

what is the initial study of choice in pancreatic cancers ?

Answer 21

CT

Question 22

what is the initial therapy for biliary obstruction?

Answer 22

endo-billiary stenting

Question 23

when should we consider Whipple’s procedure ?

Answer 23

only in patients showing resectable tumor on high quality CT