Pancreatic Neoplasms - Franco Flashcards
What are risk factors for pancreatic carcinoma?
Cigarette Smoking
Chronic pancreatitis
What are five genetic mutations linked to pancreatic cancer?
K-RAS
p16
p53
SMAD4
BRCA2
How does pancreatic cancer typically present?
Weight loss
Anorexia
Abdominal Pain
Jaundice (pancreatic head)
Steatorrhea (pancreatic head)
What radiographs are done to diganose pancreatic cancer?
What labs are done to diagnose pancreatic cancer?
Abdominal ultrasound (Jaundice)
CT (pain and weight loss)
CA 19-9 (non-specific)
How is pancreatic cancer treated?
How many cases can not be treated upon presentation?
resection (IE Whipple)
80-85% due to advanced stage
What is the difference between neoadjuvant, adjuvant, or palliative treatment?
Neo adjuvant is done before surgery to convert the patient from non-resectable to resectable
adjuvant is done after surgery to control residual disease
palliative is not curative, but treats symptoms
What are the three varieties of pancreatic cystic neoplasms?
Which are malignant?
mucinous cystic (ovarian-like with malignant potential)
intraductal papillary mucinous neoplasm (fish-eye like with malignant potential)
serous cystadenoma (glycogen-rich stellate scare, very rarely malignant)
Mucinous cystic neoplasm
Who gets it?
How is it treated?
95% in women, typically over 40
Resected regardless of size
Intraductal Papillary Mucinous neoplasm
Who gets it?
How is it treated?
anyone over 50
Main duct or mixed ducts are resected
Side branch ducts can be monitored if >3cm
Serous Cystadenoma
Who gets it?
How is it treated?
women over 60
conservative management; only removed if symptomatic
What are the five pancreatic neuroendocrine tumors?
Who gets them?
Gastrinoma, Insulinoma, Somatostatinoma, Glucagonomas, and VIPoma
Ages 40-60
What are the symptoms of a glucagonoma?
Hyperglycemia
Rash
Cheilitis
Venous Thrombosis
What are the symptoms of an insulinoma?
How can this be distinguished from insulin doping?
episodic hypoglycemia
exogenous insulin doesn’t have c-peptide
What are symptoms of somatostatinomas?
Diabetes Mellitus (caused by GIP inhibition)
cholelithiasis (caused by CCK inhibition)
steatorrhea (caused by secretin inhibition)
What are the symptoms of a VIPoma?
Watery diarrhea
hypokalemia
achlorrydria
VIPomas are also called pancreatic cholera; think of all the symptoms are having to do with fluid loss.
