pancreatic cancer

Question 1

pancreatic cancers are 95%?

Answer 1

exocrine

Question 2

5% of pancreatic cancers are?

Answer 2

neuroendocrine (insulinomas/glucagonomas)

Question 3

risk factors for pancreatic cancer?

Answer 3

age
smoking
family history 
male
obesity

Question 4

are alcohol and gallstones associated?

Answer 4

no

Question 5

is the pancreas retroperitoneal?

Answer 5

yes, apart from the tail

Question 6

symptoms ?

Answer 6

pain found in 70% (epigastric radiating to back) 
itch (increased bilirubin) - obstructive
cachexia
diarrhoea
anorexia
nausea

Question 7

why do you get pale stools and dark urine in obstructive jaundice?

Answer 7

head of pancreas obstructs bile duct. Bilirubin not draining into duodenum. Stercobilogen gives stool its cool. Urobilogen is reabsorbed and gives urine its colourless appearance

Question 8

why do you get dark urine in obstructive jaundice?

Answer 8

kidney clears conjgated bilirubin

Question 9

raised urinary bilirubin without urobilogen suggestive of?

Answer 9

obstructive jaundice (urobilogen and stercobilogen produced in bowel)

Question 10

where does pancreatic cancer spread and what would this cause?

Answer 10

lung cancer –> cause shortness of breath

Question 11

tumour marker for pancreatic cancer?

Answer 11

CA19-9

Question 12

investigations?

Answer 12

US – sensitive to masses in the biliary tree and pancreatic ducts
CXR – Can determine lung involvement
Endoscopic US or biopsy

Question 13

treatment ?

Answer 13

palliative with analgesia

Question 14

when do they usually present and what is the prognosis?

Answer 14

usually present late and have a terrible prognosis
80% have metastasised at diagnosis
mea survival 6-10 months

Question 15

raised amylase, lipase, vomiting and pain ?

Answer 15

pancreatitis

Question 16

what is courvoisiers law?

Answer 16

in the presence of a palpably enlarged gallbladder, which is non tender, in the presence of mild jaundice, the cause is unlikely to be gallstones

Question 17

man with weight loss, palpably enlarged gallbladder, jaundice. Diagnosis?

Answer 17

cancer of pancreas (or gallbladder)

Question 18

gallbladder cancer - what is it associated with?

Answer 18

gallstones

Question 19

where does cancer of the gallbladder spread?

Answer 19

liver

Question 20

what is zollinger ellison syndrome?

Answer 20

a disease in which tumours cause the stomach to produce too much acid, resulting in peptic ulcers

Question 21

painful yellow ulcer with red halo?

Answer 21

apthous ulcer

Question 22

white spidery lesion on mucosa of mouth ?

Answer 22

lichenoid planus