Pancreatic Cancer

Question 1

What is unique about the epidemiology of pancreatic cancer?

Answer 1

Poorest 5 year survival rate of any type of cancer.

Question 2

What is in the vacinity of the Pancrease?

Answer 2

Duodenum, stomach, common bile duct

Question 3

What is the major type of cancer in the pancreas?

Answer 3

Adenocarcinoma

Question 4

What is the genetic progression of pancreatic cancer?

Answer 4

Normal; Her-2/neu/K-ras/Telomere shortening; p16; p 53/DPC4/BRCA

Question 5

What is the most common mutation in Pancreatic cancer?

Answer 5

K-ras2 mutation

Question 6

What are the main risk factors for pancreatic cancer?

Answer 6

Advanced in age
Chronic pancreatitis
cigarrette smoking
Diabetes 
Chemical Exposure
Diet high in fat and meat
Partial Gastrectomy

Question 7

What factors increase risk the most?

Answer 7

Herediary Pancreatitis 60x

Family Hx of pancreas cancer 7x

Question 8

What is the presentation of Pancreatic cancer?

Answer 8

Jaundice, Weight loss, Pain, new onset of glucose intolerance.
Usually too late to cure by the time symptoms present.

Question 9

how is pancreatic cancer diagnosed?

Answer 9

Spiral CT with IV contrast. 90-95% sensitivity

Question 10

How are small tumors of the pancreas seen?

Answer 10

ERCP(Endoscopic Retrograde Cholangio Pancreatography)

Question 11

How is ERCP used to provide palliation?

Answer 11

A stent can be placed to cannalize and decrease obstruction.

Question 12

How is EUS used in PC care?

Answer 12

Aid in diagnosisand charicterization of lesion. Tissue biopsy. Lower risk of peritoneal seeding.

Question 13

Where is the most common place of mets in Pancreatic cancer?

Answer 13

liver, peritoneum and lungs.

Question 14

How is pancreatic cancer staged?

Answer 14

T1 2cm
T3 = invades into duodenum, bile duct, major veins, or peripancreatic tissues
T4= Invaes stomach, spleen, colon or Large intestine.

Question 15

What are the prognostic factors of pancreatic cancer?

Answer 15

Loc. in head of the pancreas = early symptoms, back pain, weight loss, presence of mets

Question 16

What is the treatment of Pancreatic cancer?

Answer 16

Pain: log acting opiate analgesiscs (SSRI), celiac plexus neurolysis
Weight loss
Pancreatic EZ replacement
Pruritis.

Question 17

What are the surgical treatments for PC?

Answer 17

Resection is sometimes possible. Whipple Procedure. Still a high morbidity.

Question 18

Which Meds are used for chemotherapy in PC?

Answer 18

Gemcitabine and 5-FU

Question 19

What is the challenge of delivering chemotherapy in PC?

Answer 19

The tumor is very fibrotic and not very well perfused. hard to get the drug into the tumor.

Question 20

What is the most common cystic tumor of the pancreas? others?

Answer 20

Mucinous Cystadenoma/ cystadeno CA

Intraductal Papillary mucinous neoplasm

Question 21

What are the features of Pancreatic endocrine tumors?

Answer 21

Synthesize and secrete GI hormones in unregulated manner

Question 22

What are the types of Pancreatic endocrine tumors?

Answer 22

Insulinoma(most common), Gastrinoma(zollinger-ellison)
Glucagonoma
Vasoactive Intestinal Peptide
Somatostatinoma

Question 23

What is Whipple’s triad?

Answer 23

Hypoglycemia during fasting or exercise

Serum glucose

Question 24

What is the presentation of Gastrinoma(ZE syndrome)?

Answer 24

Abdominal pain, PUD, GERD, Diarrhea. Hypercalcemia.

Mets but grows slowly. Hard to eradicate but doesn’t kill fast.

Question 25

What is the treatement of ZE syndrome.

Answer 25

Treat PUD(PPIs). Then resection.