Pancreatic Cancer Flashcards
Pancreatic cancer is what number in the most common in the UK?
1 - 1st
2 - 3rd
3 - 7th
4 - 10th
4 - 10th
- 5th cause of cancer mortality
- accounts for 3% of all new cancer diagnosis
What is the incidence of pancreatic cancer?
1 - 1.5 cases per 100,000
2 - 15 cases per 100,000
3 - 150 cases per 100,000
4 - 1500 cases per 100,000
2 - 15 cases per 100,000
At what age does pancreatic cancer most commonly present?
1 - >45
2 - >55
3 - >65
4 - >85
3 - >65
- similar likelihood in men and women
What is the overall 5 year survival of pancreatic cancer?
1 - 7-9%
2 - 17-19%
3 - 49-59%
4 - >80%
2 - 17-19%
There are lots of risk factors for pancreatic cancer. Which of the following are the 3 most common risk factors?
1 - age
2 - alcohol
3 - smoking
4 - obesity
5 - red mean consumption
6 - chronic pancreatitis / diabetes / metabolic syndrome
7 - family / genetic risk factors
2 - alcohol
3 - smoking
4 - obesity
Which gene is commonly associated with pancreatic cancer?
1 - APC
2 - BRAC-1
3 - KRAS
4 - TP53
2 - BRAC-1
There are different types of neoplastic lesions that lead to pancreatic cancer. Which is the most common?
1 - adenocarcinoma (ductal/ intraductal papillary mucinous neoplasms)
2 - mucinous cystic tumours
3 - neuroendocrine tumours
1 - adenocarcinoma (ductal/ intraductal papillary mucinous neoplasms)
Adenocarcinoma (ductal/ intraductal papillary mucinous neoplasms) are the most common neoplastic lesions that lead to pancreatic cancer. Do these commonly affect the endocrine or exocrine ducts?
- commonly exocrine ducts
- secretion of digestive enzymes, ions and water
In addition to adenocarcinoma (ductal/ intraductal papillary mucinous neoplasms) of the exocrine ducts, we can also get endocrine tumours. Which of the following is most common?
1 - insulinoma
2 - glucagonoma
3 - gastrinoma
4 - somatostatinoma
1 - insulinoma
- affect bets cells
- cause hypoglycaemic attacks due to excessive insulin production
A tumour of the islets of langerhans called a gastrinoma can cause a condition called what?
1 - carcinoid syndrome
2 - peutz-jeghers
3 - zollinger-ellison syndrome
4 - metabolic syndrome
3 - zollinger-ellison syndrome
- characterised as causing excessive gastrin release and gastric juices
- causes peptic ulcers
A tumour of the islets of langerhans called a gastrinoma can cause a condition called zollinger-ellison syndrome. Which of the following is not part of the triad of zollinger-ellison syndrome?
1 - raised gastrin
2 - peptic ulcer
3 - weight loss
4 - pancreatic tumour
3 - weight loss
Gastrin = gastric mucosal growth, gastric motility, and secretion of hydrochloric acid (HCl)
- causes peptic ulcers
Glucagonomas are caused by tumours in alpha cells of the islets of langerhans. How do these generally present?
1 - as a type 1 diabetic
2 - as NAFLD
3 - as a type 2 diabetic
3 - as a type 2 diabetic
- also causes a migratory necrolytic erythema
Which GIT malignancy has the worst prognosis?
1 - gastric
2 - pancreatic
3 - colorectal
4 - oesophageal
2 - pancreatic
There are different types of neoplastic lesions that lead to pancreatic cancer. Adenocarcinoma (ductal/ intraductal papillary mucinous neoplasms) are the most common cause of pancreatic cancer. Where is the most common part of the pancreas are these found?
1 - body
2 - tail
3 - head
4 - neck
3 - head
- accounts for aprox 60-70% of pancreatic tumours
Courvoisier’s sign is common in pancreatic cancer. Which of the following is NOT part of Courvoisier’s sign?
1 - painful gall bladder
2 - painless obstructive jaundice
3 - palpable gall bladder
4 - no presence of gallstones
1 - painful gall bladder
- it is normally pain free
- jaundice is due to malignant obstruction of biliary tree
Where is pain normally felt in a patient in pancreatic cancer?
1 - hypogastric
2 - epigastric and back
3 - right hypochondriac
4 - left lumbar
2 - epigastric and back
- hurts most when patient is lying down
Which of the following is not a clinical presentation commonly associated with pancreatic cancer?
1 - weight loss
2 - pancreatitis
3 - gallstones
4 - nausea/vomiting/reflux
5 - diabetes
6 - abdominal mass and pain
7 - excessive enzyme production (gastrin)
3 - gallstones
- most common presentations are weight loss, pain and obstructive jaundice
Patients with advanced pancreatic adenocarcinoma may experience what type of pain?
1 - general colicky left hypochondria
2 - deep and gnawing relentless pain
3 - stabbing pain in right lumbar region
4 - deep and gnawing intermittent pain
2 - deep and gnawing relentless pain
- can often drive patients to suicide and is nocturnal
- pancreatic position can be helpful
What can happen to the stool of patients with pancreatic cancer?
1 - increased diarrhoea
2 - increased constipation
3 - steatorrhoea
4 - blood stool
3 - steatorrhoea
- due to lack of pancreatic enzymes and bile secretion
Which of the following matches the criteria for a 2-week referral for suspected pancreatic cancer?
1 - anyone with Courvoisier’s sign
2 - >40 with painless jaundice
3 - >65 with painless jaundice
4 - >30 with painful gall bladder and jaundice
2 - >40 with painless jaundice
Urgent CT scan (<2 weeks) or ultrasound if CT is unavailable in > 60y/o with weight loss and any of the following:
- diarrhoea
- back pain
- abdominal pain
- nausea
- vomiting
- constipation
- new‑onset diabetes
The following are all methods for diagnosing pancreatic cancer. What is the primary method for diagnosing pancreatic cancer?
1 - Oesophago-Gastro-Duodenoscopy
2 - CT
3 - ultrasound
4 - FDG-PET/CT
2 - CT
CT is diagnostic
Ultrasound has 60-90% sensitivity
The following are all methods for diagnosing pancreatic cancer. CT is the primary method for diagnosing pancreatic cancer, however, if it is inconclusive, what method should then be used?
1 - Oesophago-Gastro-Duodenoscopy
2 - CT
3 - MRI
4 - FDG-PET/CT
4 - FDG-PET/CT
In pancreatic cancer, if we suspect biliary tree involvement, what diagnostic method should be used?
1 - Oesophago-Gastro-Duodenoscopy
2 - CT
3 - MRCP
4 - FDG-PET/CT
3 - MRCP
- ERCP can be good for palliative care
What is the tumour specific marker for tumours of the pancreas?
1 - Carbohydrate antigen 19-9 (CA19-9)
2 - Breast cancer type 1 (BRCA1)
3 - Carcinoembryonic antigen (CEA)
4 - Alpha-fetoprotein (AFP)
1 - Carbohydrate antigen 19-9 (CA19-9)
- cannot be used to diagnose, but helps
What % of patients with pancreatic cancer are suitable for surgery?
1 - 1%
2 - 20%
3 - 40%
4 - 80%
2 - 20%
Typically adjuvant is given following surgery
The main surgery for a patient with pancreatic cancer is a pancreaticoduodenectomy (whipple). Which if the following is not removed during this surgery?
1 - gall bladder
2 - head of pancreas
3 - bile duct
4 - 2nd part of the duodenum
4 - 2nd part of the duodenum
- it is the 1st part of the duodenum that is removed
- 3 anastomose needed:
- gastrojujenostomy, hepaticojejunostomy and pancreaticojejunostomy
What is the mortality rate following a pancreaticoduodenectomy (whipple) operation?
1 - 0.1%
2 - 1%
3 - 10%
4 - 30%
3 - 10%
Which of the following is NOT a common long term effect of pancreatic surgery?
1 - loss of appetite
2 - pancreatic insufficiency (diabetes, creon replacement)
3 - weight gain
4 - dumping syndrome
5 - malabsorption/malnutrition (osteoporosis)
3 - weight gain
- weigh loss is common, NOT gain
If a patient develops neutropenic sepsis due to the cancer treatment, in addition to initiating the sepsis 6, what can be given in an attempt to increase the neutrophil count?
1 -dexamethasone
2 - granulocyte colony stimulating factors (GCSF)
3 - blood transfusion
4 - frozen WBCs
2 - granulocyte colony stimulating factors (GCSF)
