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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
Q

Which BRCA type is associated with pancreatic cancer

A

BRCA2

26
Q

Other hereditary syndromes associated with pancreatic cancer

A

ATM, lynch, peutz-jeugers

27
Q

Precursor condition

A

pancreatic intraepithelial neoplasia

28
Q

Workup imaging modality

A

pancreatic protocol CT (need to repeat if just CT-abdomen, surgeons need it)

29
Q

Role for chemoRT?

A
  • ???
30
Q

metastatic disease management for patients with poor performance status

A

Single agent gemcitabine

31
Q

GEM-ABRAXANE is

A

Gemcitabine

Albumin bound paclitaxel

32
Q

In what circumstance may CA19-9 be falsely negative?

A

patients who lack Lewis antigen (also bad prognosticator)

33
Q

Role for immunotherapy in advanced pancreatic cancer

A
  • pembrolizumab is second line for MSI-H or dMMR tumors
34
Q

Preferred Adjuvant regimens

A
  • gem/capecitabine
  • **gem/abraxane not listed
  • mFOLFIRINOX
35
Q

Pathophysiology of non-secretory pancreatic cancer

A

Lacking Lewis antigen (protein found on red cells)

36
Q

T4 disease in pancreatic cancer

A
  • involvement of the celiac axis, SMA, or common hepatic artery REGARDLESS of size (this are unresectable areas)
37
Q

Vascular structures that if involved preclude surgery

A

celiac axis, SMA, or common hepatic artery

38
Q

Metastatic pancreatic cancer systemic regimens

A

1) Gemcitabine
2) gem + erlotinib
3) FOLFIRINOX
4) Gem + abraxane

39
Q

What is the modified Appleby procedure?

A

Removes two-thirds of pancreas, spleen, and celiac axis

40
Q

Clinical significance of BRCA mutation in metastatic setting

A

1) gemcitabine + cisplatin first line (confers platinum sensitivity)
2) PARP inhibitors can be used as maintenance therapy

41
Q

Clinical significance of PALB2 mutation in metastatic setting

A

Same as BRCA (another DNA repair mutation)

42
Q

Second line options

A

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
Q

Preferred adjuvant regimens

A

1) mFOLFIRINOX
2) Gemcitabine + capecitabine
* Gem/abraxane not listed

44
Q

Pathophys of IPMN?

A
  • cystic neoplasm of the pancreas with malignant potential
45
Q

what is tested for in germline testing?

A
  • DNA repair genes – BRCA 1/2, PALB2, ATM, STK11
46
Q

Surgical procedure for pancreatic cancers of the head and uncinate process

A
  • pancreatoduodenectomy (Whipple procedure)
47
Q

Surgical procedure for pancreatic cancers of the body and tail

A
  • distal pancreatectomy with en-bloc splenectomy
48
Q

Actionable somatic mutations in pancreatic cancer

A
  • ALK
  • NTRK
  • ROS1
  • KRAS
49
Q

Drugs approved for NTRK gene fusions in pancreatic cancer

A

Larotrectinib or entrectinib

50
Q

Role for chemoRT

A

1) Adjuvant setting for R1 resection

51
Q

Adjuvant Category 1 recommendations for no prior NAC

A

Gemcitabine/capecitabine
mFOLFIRINOX
*gem/abraxane not studied

52
Q

PARP maintenance trial in pancreatic - OS or PFS benefit?

A

PFS, no OS

53
Q

Most common germline mutation in hereditary pancreatitis

A

PRSS1

54
Q

Germline genetic testing indication in pancreatic

A

All patients

Hematology, oncology (218 decks)

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