Pancreatic cancer

Question 1

90% of pancreatic tumors are of what type? is it exocrine or endocrine?

Answer 1

adenocarcinoma

exocrine

Question 2

what gene is mutated in 90% of pancreatic tumors?

Answer 2

K-RAS

Question 3

which ethnicity has the highest incidence rate of pancreatic cancer?

Answer 3

African Americans

Question 4

what may be an early sign of pancreatic tumor in an elderly patient?

Answer 4

new onset glucose intolerance

Question 5

what test is used to determine presence of metastasis?

Answer 5

CT

Question 6

what test is used to determine resectability?

Answer 6

CT

Question 7

what is ERCP used for?

Answer 7

1. detecting small tumors not visualized on CT
2. palliating biliary obstruction
3. brush cytology of pancreatic duct

Question 8

what is the main sign of pancreatic tumors? why?

Answer 8

obstruction

usually involves the head of the pancreas

Question 9

what is the double duct sign?

Answer 9

obstruction leading to visualization of pancreatic duct and bile duct

Question 10

what is endocscopic US (EUS) used for?

Answer 10

1. diagnosis and characterization of lesion

2. tissue biopsy

Question 11

why is EUS considered safer than a percutaneous approach?

Answer 11

less risk of peritoneal seeding

Question 12

T3 pancreatic cancer indicates what?

Answer 12

localized invasive

Question 13

when does a patient with pancreatic cancer become symptomatic?

Answer 13

stage 3

Question 14

T4 pancreatic cancer indicates what?

Answer 14

met

Question 15

what is the serum marker for pancreatic cancer?

Answer 15

CA 19-9

Question 16

what is CA 19-9? is it tumor specific?

Answer 16

sialylated lewis A blood group antigen commonly expressed and shed in pancreatic and hepatobiliary disease

no

Question 17

CA 19-9 differentiates between what conditions?

Answer 17

pancreatic adenocarcinoma and inflammatory pancreatic disease

Question 18

what is the standard procedure for pancreatic cancer surgery? what does it entail?

Answer 18

whipple

removal of pancreas and duodenum

Question 19

what is the role of radiation in pancreatic cancer?

Answer 19

not as good as chemo alone

Question 20

what is the treatment for advanced pancreatic cancer?

Answer 20

gemcitabine

Question 21

what are the symptoms of cystic neoplasms?

Answer 21

obstruction - bloating, weight loss, jaundice

Question 22

what makes up 80% of cystic neoplasms?

Answer 22

mucinous cystadenomas

Question 23

what are the features of intraductal papillary mucinous neoplasms?

Answer 23

recurrent attacks of pancreatitis caused by mucin obstructing pancreatic duct

Question 24

how are cystic neoplasms imaged?

Answer 24

abdominal CT
EUS
biopsy

Question 25

what is the therapy for cystic neoplasms?

Answer 25

symptomatic - surgical resection

Question 26

what is the most common pancreatic endocrine tumor?

Answer 26

insulinoma

Question 27

what are the symptoms of insulinomas?

Answer 27

hypoglycemia-related

Question 28

what is the diagnosis of insulinoma?

Answer 28

whipple’s triad

1. hypoglycemia symptoms during fasting / exercise
2. serum glucose less than 50 during symptoms
3. relief of symptoms upon glucose administration

Question 29

what is the gold standard for finding an insulinoma?

Answer 29

intraoperative US and palpation

Question 30

recurrent ulcers despite treatment suggest what condition?

Answer 30

zollinger ellison syndrome

Question 31

zollinger ellision syndrome is characterized by elevation in what compound?

Answer 31

gastrin

Question 32

many zollinger ellison gastrinomas are associated with what gene mutation?

Answer 32

MEN type 1

Question 33

how are zollinger ellison gastrinomas treated?

Answer 33

PPIs