pancreatic malignancy

Question 1

Pancreatic cancer

Answer 1

Approximately 45 k pts diagnosed annually in the US, greater incidence in males and african americans.

Ductal adenocarcinoma usual, intraductal pancreatic mucinous neoplasm (IPMN) with associated invasive carcinoma. 2-3%
5% five yr survival w/o surgery (as the case w/ most patients

Question 2

Exocrine pancreatic cancer risk factors

Answer 2

cigarette smoking, chronic pancreatitis (1.8% at 10 years, 4% at 20 yrs
KRAS muttions, inactivatio of p16– inactivatio of p53-> mets to liver

Question 3

Exocrine pancreatic cancer- clincial presentation

Answer 3

Weakness, weight loss, anorexia, abdominal pain (Back, 50%, jaundice -50%,
Painless jaundice- more frequently for cancers in the pancreatic head

Question 4

Exocrine pancreatic cancer diagnosis

Answer 4

cholestatic liver pattern if biliary obstruction is present, imaging (CT most common tool)- MRI (CT or ultra sound are not good bc they block structures)

Question 5

carbonic anhydrase (CA)-19-9

Answer 5

Often normal in early stages so not useful for screening purposes

Increased values may help differentiate benign disease from cancer

Question 6

Exocrine pancreatic cancer treatment

Answer 6

usually unresectable bc of distant mets to major blood vessels

Treatment of pancreatic cancer that has not spread- surgery

Question 7

Pancreatic neuroendocrine tumors

Answer 7

Gastrinomas (Zollinger- Ellison syndrome)
Insulinoma- hypoglycemia, most common NET
Somatostainomas- DM (gastric inhibitory peptide), CCK (cholethiasis) and Secretin- steatorrhea)
Glucagonomas- hyperglycemia, rash, necrotic migratory erythema), cheilitis
VIPomas- pancreatic cholera water diarrhea, hypokalemia, achlorhydria (stimulates secretion of water intor pancreatic juice)

Not common, mid age, sporadicm inherited (ZE MEN 1, hyperpathryroidism, pituitary tumors