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MOD 3 > Pancreatic Cancer Pathology > Flashcards

Pancreatic Cancer Pathology Flashcards

1
Q

Most common type of pancreatic cancer:

Less common types of pancreatic cancer:

Overall 5 year survival of the most common type:

A

90% of pancreatic cancers = Pancreatic Ductal Adenocarcinomas (PDACs)

Less common = acinar cell carcinoma, adenosquamous, pancreative endocrine neoplasms, serous cystadenomas, mucinous cystic neoplasms

5 year survival rate of PDAC: 0.2-5%

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2
Q

Gross pathology of Pancreatic Ductal Adenocarcinoma

A

hard, gray-white (due to fibrosis and collagen), poorly defined and highly invasive mass

location:

head of pancrease (60%)

body (15%)

tail (5%)

whole gland (20%)

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3
Q

Histopathology of pancreatic cancer

A

ductal adenocarcinoma with intense desmoplasia (chronic inflammation and fibrosis)

histologic variants: adenosquamous carcinoma, colloid carcinoma, medullary carcinoma etc.

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4
Q

immunohistochemistry (6)

A
  • cytokeratins
  • CA19-9
  • mucins
  • claudins
  • mesothelin
  • EGFR
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5
Q

What does the pancreatic duct empty into?

A

duodenum

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6
Q

Metastases of pancreatic cancer

A
  • vascular and perineural invasion (through retroperitoneal space into nerves, spleen, adrenals, vertebral column, colon, and stomach)
  • to regional lymph nodes, liver, and distant sites (lungs and bones)
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7
Q

Clinical Manifestations of Pancreatic Cancer

A

Clinically silent for most of its course

  • pain (>80% of patients with advanced, means its already progressed and invaded the nerves)
  • obstructive jaundice (late phenomenon)
  • weight loss and anorexia
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8
Q

diagnostic procedures for pancreatic cancer (4)

A
  1. imaging
  2. percutaneous fine-needle aspiration
  3. pancreatic juices
  4. serum markers (cancer-associated antigen 19-9 [CA 19-9], macrophage inhibitor cytokine-1 [MIC-1])
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9
Q

staging of pancreatic cancer

A

the value of detailed clinical staging is limited

T1: limited to pancreas, <2 cm

T2: limited to pancreas, >2 cm

T3: extends beyond pancrease

T4: unresectable

Stage III (T4, N any M0): locally advanced

Stave IV (T any N any M1): metastatic

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10
Q

4 main risk factors for pancreatic cancer

A

1) cigarette smoking
2) chronic pancreatitis
3) obesity
4) family history

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11
Q

What are the 3 precursor lesions

A
  • pancreatic intrapeithelial neoplasia (PanIN = microscopic lesions in smaller pancreatic ducts)
  • intraductal papillary mucinous neoplasm (IPMN = within main pancreatic duct or one of its branches)
  • mucinous cystic neoplasm (MCN = usually found in women)
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12
Q

Main molecular pathology of pancreatic cancer

A

Activating mutations of KRAS2 (85-95%)

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13
Q

List other molecular pathologies of pancreatic cancer (7)

A
  • loss of function mutations of DPC4/SMAD4
  • activating mutations of P13KCA
  • loss of function mutations of BRCA2
  • EGFR mutations
  • dysregulation of hedgehog and Wnt-B-catenin signaling
  • telomere length abrnomalities
  • inactivation of p53 and p16/CDKN2A
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14
Q

Current therapy (4)

A
  • Surgery: pancreaticoduodenectomy (whipple procedure) in patients with localized disease (stages I-II)
  • Radiation (chemoradiotherapy)
  • Chemotherapy (gemcitabine)
  • Targeted Therapy
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15
Q

New targeted therapies - What are the three main ones?

A
  • inhibitors of EGFR family
  • inhibitors of angiogenesis
  • immune checkpoints blockade
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16
Q

What are 4 other targeted therapies

A
  • inhibitors of signal tranduction
  • inhibitors of eicosanoid pathway
  • demethylating agents
  • apoptosis inducers
17
Q

EGFR in carcinogenesis:

The ERbB (= EGFR) family comprises: (4)

A
  • ErbB-1 (=EGFR)
  • ErbB-2 (=HER-2 = HER-2neu)
  • ErbB-3 (=EGFR03 = HER-3)
  • ErbB-4 (+EGFR-4 = HER-4)
18
Q

EGFR antagonists in pancreatic cancer (2)

A
  • Erlotinib (Tarceva) + gemcitabine = randomized phase 3 trial, improvement in resposne and survave rates; FDA-approved for 1st line treatment of pancreatic cancer
  • Cetuximab (Erbitux) + gemcitabine = a single group phase 2 study, promising; a randomized phase 3 study, no survival advantage

MOD 3 (19 decks)

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