Pancreatic cancer

Question 1

Most commonly

Highly lethal

typically found in the

Answer 1

adenocarcinoma

presents in advanced stage

head

Question 2

Patho

gene association- tumor suppresors
oncogene

May be associated with

Answer 2

CDKN2A, SMAD4, P53

KRAS

fh
genetic syndromes

Question 3

AD pancreatitis predisposes to

Mutation

Rf

Answer 3

pancreatic adenocarcinoma

PRSS1

smoking, chronic pancreatitis, inactivity, obesity

Question 4

CM

Head

Body/tail

Answer 4

H- diarrhea, jaundice, Vpain
steatorrhea (lack of lipase)
pain worse at night/eating

B/T- pain, anorexia, wl

Question 5

Physical exam suggestive findings

Answer 5

palpable ab mass
ascites
supraclavicular LAD (virchow)
Palpable periumbilical mass (Sister Mary Joseph)
Troussea (hypercoag)

Question 6

Head of pancreas associated with

Invasion of vasculature

Direct metastases to

Answer 6

pancreatic duct, CBD- jaundice/malabsorption

SMV, portal vein
SMA/celiac A
Regional LN

liver/peritoneum/lung

Question 7

Dx tests

Beyond CT

Tumor marker association

Ultimate dx

Path appearance

Answer 7

CT (id obstructive jaundice)

MRCP/ERCP

CA 19-9

biopsy (EUS preffered)

Hard, grey/white, mass
dense stromal fibrosis

Question 8

Mx

Whipple procedure (pancreaticduodenectomy)

Distal pancreatectomy/splenectomy

Chemo agents

Advanced

Answer 8

surgical resection

localized to head
Removes pancreas head, duo, jejunum, CBD, GB, stomach

localized to body/tail

alongside
5FU, gemcitabine

Gem, Gem +pac, Gem + capecitabine, FOLFIRINOX

Question 9

Neuroendocrine tumors

Can be

MC functining
sx

Answer 9

islet cell tumors

functioning/non (majority)

insulinomas- hypoglycemia w fasting
headache, confusion, sweating/trmor/palp

Question 10

Gastrinoma
mc sx

Glucagonomas

VIPomas

Answer 10

inc gastric acid sec

ab pain, PUD, diarrhea, GERD

generalized dermatitis, glucose intolerance, DM, wl, diarrhea

inc VIP- watery diarrhea, hypoK/Cl, dehydration