pancreatic cancer Flashcards
origin and risk factors for pancreatic adenocarcinoma
originates in the duct cell anywhere in pancreas but most commonly the head.
RF:
old age, male gender, SMOKING, chronic pancreatitis, alcohol abuse, genetic (lynch syndrome (HNPCC) )
symptoms of pancreatic adenocarcinoma? diagnosis difficulty?
-weight loss, loss of appetite
-belt-like epigastric pain radiating to the back
-enlarged non-tender gallbladder with jaundice (tumor obstructs the CBD, causing jaundice and bile backs up into the gallbladder)
-malabsorption, diarrhea and possibly steatorrhea
-trousseau syndrome (migratory superficial thrombophlebitis) rare but CLASSICALLY associated with pancreatic cancer
symptoms are similar to chronic pancreatitis and diagnosis may be difficult due to them co-existing
diagnosis and treatment of pancreatic adenocarcinoma? prognosis?
US is the initial test for any patient presenting with jaundice
-ct abdomen with contrast (hypodense mass with classic double duct sign from obstruction of CBD and pancreatic duct from tumor in the head)
-endoscopic US guided biopsy
-routine labs (CBC, LFT, pancreatic enzymes usually high)
-high CEA, CA-19-9 tumor markers used mostly for monitoring treatment NOT diagnosis
if head tumor: pancreaticoduodenectomy (whipple)
if body and tail: distal/left peancreatectomy with splenectomy
if non resectable then palliative with ERCP and stent with 4-5 months survival. most die within 1 yr regardless
insulinoma symptoms, diagnosis, treatment?
-hypoglycemia (lethargy, syncope, sweating, palpitations) after fasting or exercise
-relief of symptoms after eating
-documented/measured hypoglycemia
-weight gain due to anabolic effect of insulin
-diagnosed by fasting insulin (high) and abdomen CT
-tx by surgical resection
gastrinoma define, symptoms, diagnosis, treatment?
known as zollinger-ellison syndrome
-symptoms suggestive of peptic ulcer (epigastric pain worse after meals, vomit blood). increasing dose of PPI
-diagnosis by fasting gastrin (high), secretin stimulation (increased gastrin instead of inhibit gastrin release), endoscopy shows multiple ulcers in atypical locations
-tx by surgical resection and PPI
VIPoma define, symptoms, diagnosis, treatment?
also known as WDHA (watery diarrhea, hypokalemia, achlorhydria)
-watery diarrhea
-hypokalemia (palpitations, muscle fasciculations, tetany)
-diagnosis by fasting VIP level
-treatment by surgical resection
glucagonoma symptoms, diagnosis, treatment?
mild diabetes
anemia
mucositis
necrolytic migratory erythema- red psoriatic like rash with wavy margins
diagnosis by fasting glucagon level
tx is surgery
CLASSIC SIGN OF PANCREATIC ADENOCARCINOMA
PAINLESS JAUNDICE
