Sketchy Path: Pancreatic and Islet Cell Tumors

Question 1

What is the most important RF for adenocarcinoma of the pancreas?

Answer 1

Smoking

Question 2

What is the genetic mutation assc with familial pancreatic adenocarcinoma?

Answer 2

BRCA 1 and 2

Question 3

What genetic mutation is present in almost all pancreatic cancers?

Answer 3

KRAS

Question 4

What two tumor suppressor gene is a risk factor for pancreatic adenocarcinoma?

Answer 4

CDKN2A and SMAD4

Question 5

Where is the most common place for pancreatic adenocarcinoma?

Answer 5

Head of the pancreas

Question 6

What type of hyperbillirubinemia is caused by pancreatic adenocarcinoma?

Answer 6

Obstructs the common bile duct and leads to an increase of conjugated bilirubin -> pale/clay stools and dark urine

Question 7

What is Courvoisier’s Sign?

Answer 7

A palpable non-tender gallbladder assc with Jaundice

Question 8

Superficial migratory thrombophlebitis can be caused by pancreatic adenocarcinoma and is termed?

Answer 8

Trousseau’s Syndrome

Question 9

Pancreatic Adenocarcinoma can cause what adrenal pathology?

Answer 9

Cushing Syndrome

Question 10

What serum markers are elevated in pancreatic cancer?

Answer 10

CEA
CA 19-9
Not used to diagnose but can track progression

Question 11

What part of the pancreas has neuroendocrine functions?

Answer 11

Islet of Langerhaans

Question 12

What is the most common pancreatic neuroendocrine tumor?

Answer 12

Insulinoma

beta cell tumor

Question 13

What signs would you get in a person with Insulinoma?

Answer 13

Hypoglycemia

Tremors, diaphoresis, and confusion

Question 14

A patient with an insulinoma may tell you that they feel better after what?

Answer 14

They eat

Question 15

What is Whipple’s Triad?

Answer 15

Hypoglycemia symptoms (tremors, confusion)
Feel better after eating
Low blood glucose

Question 16

Besides insulin itself, what other molecule will be elevated in the blood?

Answer 16

C-Peptide
(only elevated when you are making too much ENDOGENOUS insulin therefore would not be elevated in someone who took too much synthetic insulin)

Question 17

Glucagonomas cause what?

Answer 17

Hypergylcemia

Question 18

What are some other symptoms of Glucagonomas?

Answer 18

GI Side effects
Weight Loss
Depression/Dementia
Dellusions

Question 19

A large percentage of patients with Glucagonoma will suffer what type of event?

Answer 19

Venous thrombosis (DVT or PE)

Question 20

What of the most classic features of Glucagonoma is what skin manifestation?

Answer 20

Necrolytic Migratory Erythema

epidural necrosis causing migrating erythematous plaques, usually affects extremities and perioral region

Question 21

Gastrinoma cause a cluster of symptoms known as?

Answer 21

Zollinger- Ellison Syndrome

Question 22

An ulcer in the Jejunum is a red flag for what?

Answer 22

Zollinger-Ellison / Gastrinoma

Question 23

What is the most common presenting symtpoms in those with ZE syndrome?

Answer 23

Diarrhea
Abd Pain
GERD

Question 24

What test can be performed if you are unsure of a gastrinoma?

Answer 24

Secretin Test

normally secretin would inhibit the release of gastrin but it has the opposite affect on a gastrinoma

Question 25

Pancreatic Cholera occurs due to what tumor?

Answer 25

VIPomas

Question 26

Large volumous diarrhea from a VIPoma can lead to what?

Answer 26

Hypokalemia
Achlorhydria
Dehydration

Question 27

MEN1 has what tumors?

Answer 27

Pituitary
Parathyroid
Pancreatic

Question 28

Somatostatinoma’s symptoms?

Answer 28

Malabsorption diarrhea
Gallstones (decrease CCK)
Achlorhydria (decrease gastrin)
Hyperglycemia

Question 29

What drug can decrease the symtpoms of pancreatic neuroendocrine tumors?

Answer 29

Octerotide

mostly for VIPomas and Gastrinomas