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A. MLA Map Oncology > Pancreatic Cancer > Flashcards

Pancreatic Cancer Flashcards

1
Q

Pancreatic cancer is what number in the most common in the UK?

1 - 1st
2 - 3rd
3 - 7th
4 - 10th

A

4 - 10th

  • 5th cause of cancer mortality
  • accounts for 3% of all new cancer diagnosis
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2
Q

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

A

2 - 15 cases per 100,000

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3
Q

At what age does pancreatic cancer most commonly present?

1 - >45
2 - >55
3 - >65
4 - >85

A

3 - >65

  • similar likelihood in men and women
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4
Q

What is the overall 5 year survival of pancreatic cancer?

1 - 7-9%
2 - 17-19%
3 - 49-59%
4 - >80%

A

2 - 17-19%

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5
Q

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

A

2 - alcohol
3 - smoking
4 - obesity

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6
Q

Which gene is commonly associated with pancreatic cancer?

1 - APC
2 - BRAC-1
3 - KRAS
4 - TP53

A

2 - BRAC-1

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7
Q

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

A

1 - adenocarcinoma (ductal/ intraductal papillary mucinous neoplasms)

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8
Q

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?

A
  • commonly exocrine ducts
  • secretion of digestive enzymes, ions and water
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9
Q

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

A

1 - insulinoma

  • affect bets cells
  • cause hypoglycaemic attacks due to excessive insulin production
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10
Q

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

A

3 - zollinger-ellison syndrome

  • characterised as causing excessive gastrin release and gastric juices
  • causes peptic ulcers
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11
Q

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

A

3 - weight loss

Gastrin = gastric mucosal growth, gastric motility, and secretion of hydrochloric acid (HCl)
- causes peptic ulcers

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12
Q

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

A

3 - as a type 2 diabetic

  • also causes a migratory necrolytic erythema
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13
Q

Which GIT malignancy has the worst prognosis?

1 - gastric
2 - pancreatic
3 - colorectal
4 - oesophageal

A

2 - pancreatic

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14
Q

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

A

3 - head

  • accounts for aprox 60-70% of pancreatic tumours
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15
Q

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

A

1 - painful gall bladder

  • it is normally pain free
  • jaundice is due to malignant obstruction of biliary tree
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16
Q

Where is pain normally felt in a patient in pancreatic cancer?

1 - hypogastric
2 - epigastric and back
3 - right hypochondriac
4 - left lumbar

A

2 - epigastric and back

  • hurts most when patient is lying down
17
Q

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)

A

3 - gallstones

  • most common presentations are weight loss, pain and obstructive jaundice
18
Q

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

A

2 - deep and gnawing relentless pain

  • can often drive patients to suicide and is nocturnal
  • pancreatic position can be helpful
19
Q

What can happen to the stool of patients with pancreatic cancer?

1 - increased diarrhoea
2 - increased constipation
3 - steatorrhoea
4 - blood stool

A

3 - steatorrhoea

  • due to lack of pancreatic enzymes and bile secretion
20
Q

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

A

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
21
Q

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

A

2 - CT

CT is diagnostic

Ultrasound has 60-90% sensitivity

22
Q

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

A

4 - FDG-PET/CT

23
Q

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

A

3 - MRCP

  • ERCP can be good for palliative care
24
Q

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)

A

1 - Carbohydrate antigen 19-9 (CA19-9)

  • cannot be used to diagnose, but helps
25
Q

What % of patients with pancreatic cancer are suitable for surgery?

1 - 1%
2 - 20%
3 - 40%
4 - 80%

A

2 - 20%

Typically adjuvant is given following surgery

26
Q

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

A

4 - 2nd part of the duodenum

  • it is the 1st part of the duodenum that is removed
  • 3 anastomose needed:
  • gastrojujenostomy, hepaticojejunostomy and pancreaticojejunostomy
27
Q

What is the mortality rate following a pancreaticoduodenectomy (whipple) operation?

1 - 0.1%
2 - 1%
3 - 10%
4 - 30%

A

3 - 10%

28
Q

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)

A

3 - weight gain

  • weigh loss is common, NOT gain
29
Q

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

A

2 - granulocyte colony stimulating factors (GCSF)

A. MLA Map Oncology (27 decks)

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