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Gen Surgery > Pancreatic Neoplasms > Flashcards

Pancreatic Neoplasms Flashcards

1
Q

What percentage of pancreatic cancers are pancreatic ductal adenocarcinomas

A

More than 85%

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2
Q

What percentage of pancreatic adenocarcinomas occur between the ages of 60- 80 years old

A

80%

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3
Q

What percentage of pancreatic ductal carcinomas occur in the head of the pancreas

A

65%

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4
Q

What are the well defined cancer predisposing syndromes that patients with pancreatic adenocarcinoma may present with

A
  • hereditary non-polyposis colon cancer
  • familial breast cancer
  • familial syndrome adenomatous polyposis
  • peutz-jeugers
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5
Q

Risk factors for the development of pancreatic cancer

A
  • predisposing cancer syndrome
  • smoking
  • chronic pancreatitis
  • possible risk factors: diabetes meillitus, obesity
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6
Q

Clinical presentation of pancreatic cancer (History)

A
  • Painless obstructive jaundice: cancer of the head of the pancreas
  • Upper abdominal pain that radiates to the back, mimic peptic ulcer disease and irritable bowel syndrome
  • Weight loss
  • Late onset diabetes (atypical diabetes)
  • Gastric outlet obstruction
  • Ascites
  • Abdominal mass
  • Thrombophlebitis migrans
  • Dyspepsia
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7
Q

Features of advanced disease in pancreatic cancer

A
  • Virchow’s node

- Sister Mary Joseph Nodule

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8
Q

Lab studies done in suspected pancreatic neoplasms

A
  • Rise in serum bilirubin, ALP and GGT

- High CA 19-9 is the most useful tumour marker

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9
Q

Uses of trans-abdominal ultrasound in the work up for pancreatic cancer

A
  • First line investigation in patietn with jaundice
  • Detects biliary and pancreatic duct dilation (double duct sign), Liver metastasis and ascites
  • Not good at detecting pancreatic masses less than 2 cm in size or assessment of vascular invasion
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10
Q

Radiological investigation of choice in pancreatic cancer

A

Multiphase, helical computed tomography

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11
Q

When is ERCP done in work up for pancreatic cancer

A

-Reserved for palliative billiary stenting or when there is a suspicion of periampullary tumour

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12
Q

When is a staging laparoscopy done

A
  • Equivocal CT findings
  • marked weight loss
  • Severe pain
  • markedly elevated CA19-9 levels
  • It is used to detect as yet undiagnosed peritoneal deposits or liver metastasis
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13
Q

Factors contraindicating surgical resection of pancreatic neoplasm

A
  • Presence of metastatic disease
  • Lymph node involvement
  • major vessel involvement (SMA, coelic artery, hepatic artery, portal or superior mesenteric veins
  • Comorbid disease
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14
Q

What procedure is used for resection of tumors in the head or ucinate process of pancreas

A

Pancreaticoduodenectomy (Whipple’s procedure)

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15
Q

What procedure is used for resection of tumors in the body and tail of the pancreas

A

distal pancreatectomy

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16
Q

What three anastomosis are done in a whipples procedure

A
  • Hepaticojejenostomy
  • Pancreaticojejenostomy
  • Gastrojejenostomy
17
Q

Most common complications of pancreatic resection

A
  • Pancreatic fistula
  • Intra-abdominal collections
  • Haemorrhage
  • Delayed gastric emptying
18
Q

When should preoperative biliary decompression be considered in pancreatic cancer

A
  • Cholangitis
  • Advanced malnutrition
  • Significant time delay before surgery
19
Q

Which symptoms most commonly need treatment in the palliative treatment of pancreatic cancer, how do you manage them?

A
  • Obstructive jaundice: endoscopically placed stent / hepaticojejenostomy
  • Gastric outlet obstruction: endoscopic duodenal stenting/ Gastrojejenostomy
  • Pain: opiates, NSAIDS, coeliac plexus block
20
Q

What adjuvant therapy is used in pancreatic cancer

A

Adjuvant gemcitabine chemotherapy

21
Q

epidemiology of insulinomas

A
  • Male:female - 2:1

- Most common in patients 40 - 50 years old

22
Q

Whipple’s triad in insulinoma

A
  • Symptoms of hypoglycaemia
  • Concomitant blood glucose level of <5 mmol/L
  • Relief of hypoglycemia with glucose administration
23
Q

How is the diagnosis of insulinoma confirmed

A

-Elevatated c peptide levels and insulin levels during episode hypoglycemia

24
Q

Most sensitive test for localising insulinomas

A

Endoscopic ultrasonography

25
Q

Management of insulinomas

A
  • Consume small frequent meals
  • Medical: diazoxide and verapamil
  • Pre-op: dextrose infusion, stopped 2 hours pre-op
  • Enucleation operation of choice in beneign insulinomas
  • Signs of malignancy: pancreatic resection
26
Q

Symptoms of gastrinomas

A
  • Fulminant peptic ulcer syndrome
  • Peptic ulcers that are refractory to treatment
  • Diarrhea (improves with PPI or NG tube)
27
Q

How is the diagnosis of gastrinoma established

A
  • Gastric acid hypersecretion (>15mEq/hr)
  • Hypergastrinaemia (fasting level >500pg/ml)
  • patients should have stopped PPIs and H2 blockers one week prior to testing
28
Q

management of gastrinoma

A
  • Started on anti-secretory medication (high dose PPI)
  • Surgery benefits all with sporadic gastrinoma
  • Role of surgery in MEN-1 syndrome is debated
  • Small well encapsulated pancreatic tumours are managed with enucleation
  • Larger/not well encapsulated: distal pancreatectomy / pancreaticoduodenectomy
29
Q

What is the gastrinoma triangle

A
  • Bounded by:
  • Cystic duct
  • The borders of the 2nd and third part of the duodenum
  • The junction of the neck and body of the pancreas
30
Q

methods of localizing gastrinomas

A

Pre-op: endoscopic ultrasound and octreotide scanning

Intra-op: palpation, endoscopic transillumination and ultrasound. If this fails –> longitudinal duodenectomy

31
Q

Clinical features of glucagonoma

A

Cachexia, malnutrition, protein depletion, characteristic rash (necrolytic migratory erythema), glucose intolerance and deep venous thrombosis

32
Q

Average tumor size of glucagonoma at time of diagnosis

A

5 cm

33
Q

Localisation of glucagonomas

A

CT scan

34
Q

Management of glucagonoma

A

Complete surgical resection is the only possibility of a cure

35
Q

More than 90 % of pancreatic cysts are ?

A

Pseudocysts associated with acute or chronic pancreatitis

36
Q

The four types of pancreatic cystic neoplasms

A
  • Serous cystic neoplasms
  • Mucinous cystic neoplasms
  • Intraductal papillary mucinous neoplasms
  • Solid pseudopapillary neoplasms
37
Q

Which pancreatic cystic neoplasms undergo malignant transformation

A
  • Mucinous cystic neoplasms
  • -Intraductal papillary mucinous neoplasms
  • Solid pseudopapillary neoplasms
38
Q

What is the lipase hypersecretion syndrome associated with acinar cell tumours

A
  • Subcutaneous fat necrosis
  • Polyathralgias
  • Eosinophilia

Gen Surgery (31 decks)

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