Pancreatic Cancer Flashcards
What is unique about the epidemiology of pancreatic cancer?
Poorest 5 year survival rate of any type of cancer.
What is in the vacinity of the Pancrease?
Duodenum, stomach, common bile duct
What is the major type of cancer in the pancreas?
Adenocarcinoma
What is the genetic progression of pancreatic cancer?
Normal; Her-2/neu/K-ras/Telomere shortening; p16; p 53/DPC4/BRCA
What is the most common mutation in Pancreatic cancer?
K-ras2 mutation
What are the main risk factors for pancreatic cancer?
Advanced in age Chronic pancreatitis cigarrette smoking Diabetes Chemical Exposure Diet high in fat and meat Partial Gastrectomy
What factors increase risk the most?
Herediary Pancreatitis 60x
Family Hx of pancreas cancer 7x
What is the presentation of Pancreatic cancer?
Jaundice, Weight loss, Pain, new onset of glucose intolerance.
Usually too late to cure by the time symptoms present.
how is pancreatic cancer diagnosed?
Spiral CT with IV contrast. 90-95% sensitivity
How are small tumors of the pancreas seen?
ERCP(Endoscopic Retrograde Cholangio Pancreatography)
How is ERCP used to provide palliation?
A stent can be placed to cannalize and decrease obstruction.
How is EUS used in PC care?
Aid in diagnosisand charicterization of lesion. Tissue biopsy. Lower risk of peritoneal seeding.
Where is the most common place of mets in Pancreatic cancer?
liver, peritoneum and lungs.
How is pancreatic cancer staged?
T1 2cm
T3 = invades into duodenum, bile duct, major veins, or peripancreatic tissues
T4= Invaes stomach, spleen, colon or Large intestine.
What are the prognostic factors of pancreatic cancer?
Loc. in head of the pancreas = early symptoms, back pain, weight loss, presence of mets
What is the treatment of Pancreatic cancer?
Pain: log acting opiate analgesiscs (SSRI), celiac plexus neurolysis
Weight loss
Pancreatic EZ replacement
Pruritis.
What are the surgical treatments for PC?
Resection is sometimes possible. Whipple Procedure. Still a high morbidity.
Which Meds are used for chemotherapy in PC?
Gemcitabine and 5-FU
What is the challenge of delivering chemotherapy in PC?
The tumor is very fibrotic and not very well perfused. hard to get the drug into the tumor.
What is the most common cystic tumor of the pancreas? others?
Mucinous Cystadenoma/ cystadeno CA
Intraductal Papillary mucinous neoplasm
What are the features of Pancreatic endocrine tumors?
Synthesize and secrete GI hormones in unregulated manner
What are the types of Pancreatic endocrine tumors?
Insulinoma(most common), Gastrinoma(zollinger-ellison)
Glucagonoma
Vasoactive Intestinal Peptide
Somatostatinoma
What is Whipple’s triad?
Hypoglycemia during fasting or exercise
Serum glucose
What is the presentation of Gastrinoma(ZE syndrome)?
Abdominal pain, PUD, GERD, Diarrhea. Hypercalcemia.
Mets but grows slowly. Hard to eradicate but doesn’t kill fast.
What is the treatement of ZE syndrome.
Treat PUD(PPIs). Then resection.
