Pancreatic Neoplasia CIS (Tieman)

Question 1

some things associated with pancreatic cancer

Answer 1

smoking
diabetes
weight loss
obesity

Question 2

courvoisier’s sign

Answer 2

palpable gallbladder in the face of painless obstructive jaundice

pathognomonic for adenocarcinoma of the head of the pancreas

Question 3

how to work up carcinoma of the head of the pancreas

Answer 3

diagnostic study of choice- CT

Question 4

CA 19-99 and CEA

Answer 4

markers we use to track pancreatic cancer patients to see if it is coming back

Question 5

the part of the pancreas that’s posterior to the artery and vein

Answer 5

uncinate process

Question 6

vascular invasion of the superior mesenteric vessels or the portal vessels

Answer 6

the definition of unresectable

Question 7

neoadjuvant

Answer 7

do something before the definitive procedure (like chemo before the surgery)

adjuvant is the opposite

Question 8

best treatment of pancreatic cancer

Answer 8

surgery

Question 9

cutoff for removing a cystic neoplasm

Answer 9

usually 3 cm and larger- remove

also, always remove mucinous

high CEA levels also

we can leave serous ones alone and follow them–characterized by scarring

Question 10

mucinous cystadenomas

Answer 10

found exclusively in women

look like ovarian tissue

usually older women

Question 11

gastrinomas produce

Answer 11

ulcers and watery diarrhea

most are found in the wall of the duodenum

Question 12

insulinomas cause

Answer 12

hypoglycemia

Question 13

VIPoma symptoms

Answer 13

vasoactive intestinal peptide

diffuse watery diarrhea and hypochloridemia, hypokalemia

Question 14

test to see if we have a gastrinoma?

Answer 14

secretin stimulation test- gastrin would go up like crazy

Question 15

neuroendocrine tumors and malignancy

Answer 15

almost all of them are malignant

needle aspiration doesn’t tell you much, either.

Question 16

“Islet Cell Tumors”

Answer 16

Nonfunctional:
Often diagnosed because of non-specific ABD symptoms attributable to mass effect or metastases

Functional:
Produce dramatic symptoms d/t excess hormone release
Recognized Types:
Insulinoma
Gastrinoma
Glucagonoma
VIPoma
Somatostatinoma

Question 17

dx of neuroendocrin tumors

Answer 17

Tumor localization & staging studies include imaging with CT, with or without MRI, & endoscopic U/S

Somatostatin-receptor scintigraphy & single-photon emission CT may also be useful adjuncts

If noninvasive tests do not reveal tumor, but clinical suspicion remains high, selective arteriography or selective arterial stimulation w/ a secretagogue specific for the suspected tumor type may be useful

Question 18

Treatment of neuroendocrin tumors

Answer 18

Localized Disease:
1o management of endocrine tumors of the pancreas involves surgical resection w/ curative intent

Metastases:
Symptoms of metastatic functional pancreatic NETs may be ameliorated by the reduction of overall tumor burden through surgical debulking
– Surgical resection; Gel-foam embolization or transarterial chemoembolization; Radioembolization w/ radioactive microspheres; Radiofrequency ablation; Cryoablation; Percutaneous alcohol ablation

Advanced & Metastatic Disease:
- Somatostatin analogs
- Chemotherapy:
Streptozocin; Doxorubicin; 5-FU; Chlorozotocin; Dacarbazine; Temozolomide; Sunitinib; VEGF inhibitors; Everolimus

With the exception of pain relief from bone metastases, external beam irradiation therapy has limited role in treatment of pancreatic neuroendocrine tumors; however, in those tumors or metastases that have somatostatin receptors, targeted radiation (radioactive isotope attached to somatostatin) may have a role.