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Hematology, oncology > Pancreatic cancer > Flashcards

Pancreatic cancer Flashcards

1
Q

breakdown of pancreatic cancer anatomy/location

A

2/3’s of tumors are located in head of pancreas

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2
Q

RF’s for pancreatic cancer

A

1) smoking
2) DM2
3) chronic pancreatitis
4) genetic RF’s (peutz-jeghers, lynch, BRCA, ATM)

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3
Q

clinical significance of pancreatic intraepithelial neoplasia

A

precursor lesion to ductal adenocarcinoma

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4
Q

presentation of pancreatic cancer

A

IF head –> jaundice + pain
IF body/tail –> asymptomatic
New onset or worsening diabetes, thrombophlebitis, pancreatitis

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5
Q

histological subtypes of pancreatic cancer

A
  • most are adenocarcinoma, neuroendocrine also but much less common
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6
Q

tumor marker for pancreatic cancer

A

CA 19-9

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7
Q

features precluding resection of pancreatic cancer

A

distant mets
SMA involvement
hepatic or celiac artery involvment
portal vein occlusion

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8
Q

surgery type used for resection of tumor in pancreatic head

A

whipple procedure

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9
Q

how whipple procedure works

A

removal of pancreatic head along with distal stomach, gallbladder, cystic and common bile ducts, duodenum, and proximal jejunum

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10
Q

typical adjuvant chemo

A

5-FU or gemcitabine or FOLFIRINOX

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11
Q

pancreatic cancer associated with which BRCA type

A

Type 2

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12
Q

Stage of presentation of most pancreatic cancer

A

Majority of patients have unresectable or metastatic disease at diagnosis

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13
Q

location of most tumors at presentation

A

(2/3’s in head)

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14
Q

Histologic subtypes of pancreatic cancer

A
  • most are adenocarcinomas

- neuroendocrine tumors (much less common)

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15
Q

Features of unresectable pancreatic cancer

A

Distant mets
Superior mesenteric or portal vein encasement or occlusion
SMA involvement
hepatic artery or celiac artery involvement

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16
Q

Targeted therapies for pancreatic cancer

A

PARP inhibitors for BRCA (though very low prevalence around 5%)

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17
Q

management of surgically resectable pancreatic cancer

A

Trend CA19-9

Surgery, then adjuvant chemo +/- radiation

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18
Q

management of non-surgically resectable pancreatic cancer

A

Trend CA19-9
Palliative chemotherapy
Palliative care consult

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19
Q

typical palliative chemo regimen

A

FOLFIRINOX OR gemcitabine + nab-paclitaxel

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20
Q

Role for MRI in pancreatic cancer workup

A

indeterminate lesions on CT abdomen

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21
Q

Preferred NAC regimens

A

Modified FOLFIRINOX OR gemcitabine + nab-paclitaxel

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22
Q

What is modified folfirinox?

A

No 5-Fu bolus

23
Q

Surgery type for tumor in pancreatic body and tail

A

Distal pancreatectomy with en bloc splenectomy

24
Q

Management of patient with hyperbilirubinemia/jaundice from obstruction

A

Consult GI for endoscopic stenting

25
Which BRCA type is associated with pancreatic cancer
BRCA2
26
Other hereditary syndromes associated with pancreatic cancer
ATM, lynch, peutz-jeugers
27
Precursor condition
pancreatic intraepithelial neoplasia
28
Workup imaging modality
pancreatic protocol CT (need to repeat if just CT-abdomen, surgeons need it)
29
Role for chemoRT?
- ???
30
metastatic disease management for patients with poor performance status
Single agent gemcitabine
31
GEM-ABRAXANE is
Gemcitabine | Albumin bound paclitaxel
32
In what circumstance may CA19-9 be falsely negative?
patients who lack Lewis antigen (also bad prognosticator)
33
Role for immunotherapy in advanced pancreatic cancer
- pembrolizumab is second line for MSI-H or dMMR tumors
34
Preferred Adjuvant regimens
- gem/capecitabine * **gem/abraxane not listed - mFOLFIRINOX
35
Pathophysiology of non-secretory pancreatic cancer
Lacking Lewis antigen (protein found on red cells)
36
T4 disease in pancreatic cancer
- involvement of the celiac axis, SMA, or common hepatic artery REGARDLESS of size (this are unresectable areas)
37
Vascular structures that if involved preclude surgery
celiac axis, SMA, or common hepatic artery
38
Metastatic pancreatic cancer systemic regimens
1) Gemcitabine 2) gem + erlotinib 3) FOLFIRINOX 4) Gem + abraxane
39
What is the modified Appleby procedure?
Removes two-thirds of pancreas, spleen, and celiac axis
40
Clinical significance of BRCA mutation in metastatic setting
1) gemcitabine + cisplatin first line (confers platinum sensitivity) 2) PARP inhibitors can be used as maintenance therapy
41
Clinical significance of PALB2 mutation in metastatic setting
Same as BRCA (another DNA repair mutation)
42
Second line options
1) Given previous treatment with gemcitabine-based therapy, 5-Fu + leucovorin + liposomal irinotecan (NAPOLI 1 Study, OS of 6.1 months) 2) Given dMMR or MSI-H, pembrolizumab
43
Preferred adjuvant regimens
1) mFOLFIRINOX 2) Gemcitabine + capecitabine * Gem/abraxane not listed
44
Pathophys of IPMN?
- cystic neoplasm of the pancreas with malignant potential
45
what is tested for in germline testing?
- DNA repair genes -- BRCA 1/2, PALB2, ATM, STK11
46
Surgical procedure for pancreatic cancers of the head and uncinate process
- pancreatoduodenectomy (Whipple procedure)
47
Surgical procedure for pancreatic cancers of the body and tail
- distal pancreatectomy with en-bloc splenectomy
48
Actionable somatic mutations in pancreatic cancer
- ALK - NTRK - ROS1 - KRAS
49
Drugs approved for NTRK gene fusions in pancreatic cancer
Larotrectinib or entrectinib
50
Role for chemoRT
1) Adjuvant setting for R1 resection
51
Adjuvant Category 1 recommendations for no prior NAC
Gemcitabine/capecitabine mFOLFIRINOX *gem/abraxane not studied
52
PARP maintenance trial in pancreatic - OS or PFS benefit?
PFS, no OS
53
Most common germline mutation in hereditary pancreatitis
PRSS1
54
Germline genetic testing indication in pancreatic
All patients

Hematology, oncology (218 decks)

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