Sketchy Path: Pancreatic and Islet Cell Tumors Flashcards
What is the most important RF for adenocarcinoma of the pancreas?
Smoking
What is the genetic mutation assc with familial pancreatic adenocarcinoma?
BRCA 1 and 2
What genetic mutation is present in almost all pancreatic cancers?
KRAS
What two tumor suppressor gene is a risk factor for pancreatic adenocarcinoma?
CDKN2A and SMAD4
Where is the most common place for pancreatic adenocarcinoma?
Head of the pancreas
What type of hyperbillirubinemia is caused by pancreatic adenocarcinoma?
Obstructs the common bile duct and leads to an increase of conjugated bilirubin -> pale/clay stools and dark urine
What is Courvoisier’s Sign?
A palpable non-tender gallbladder assc with Jaundice
Superficial migratory thrombophlebitis can be caused by pancreatic adenocarcinoma and is termed?
Trousseau’s Syndrome
Pancreatic Adenocarcinoma can cause what adrenal pathology?
Cushing Syndrome
What serum markers are elevated in pancreatic cancer?
CEA
CA 19-9
Not used to diagnose but can track progression
What part of the pancreas has neuroendocrine functions?
Islet of Langerhaans
What is the most common pancreatic neuroendocrine tumor?
Insulinoma
beta cell tumor
What signs would you get in a person with Insulinoma?
Hypoglycemia
Tremors, diaphoresis, and confusion
A patient with an insulinoma may tell you that they feel better after what?
They eat
What is Whipple’s Triad?
Hypoglycemia symptoms (tremors, confusion)
Feel better after eating
Low blood glucose
Besides insulin itself, what other molecule will be elevated in the blood?
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)
Glucagonomas cause what?
Hypergylcemia
What are some other symptoms of Glucagonomas?
GI Side effects
Weight Loss
Depression/Dementia
Dellusions
A large percentage of patients with Glucagonoma will suffer what type of event?
Venous thrombosis (DVT or PE)
What of the most classic features of Glucagonoma is what skin manifestation?
Necrolytic Migratory Erythema
epidural necrosis causing migrating erythematous plaques, usually affects extremities and perioral region
Gastrinoma cause a cluster of symptoms known as?
Zollinger- Ellison Syndrome
An ulcer in the Jejunum is a red flag for what?
Zollinger-Ellison / Gastrinoma
What is the most common presenting symtpoms in those with ZE syndrome?
Diarrhea
Abd Pain
GERD
What test can be performed if you are unsure of a gastrinoma?
Secretin Test
normally secretin would inhibit the release of gastrin but it has the opposite affect on a gastrinoma
Pancreatic Cholera occurs due to what tumor?
VIPomas
Large volumous diarrhea from a VIPoma can lead to what?
Hypokalemia
Achlorhydria
Dehydration
MEN1 has what tumors?
Pituitary
Parathyroid
Pancreatic
Somatostatinoma’s symptoms?
Malabsorption diarrhea
Gallstones (decrease CCK)
Achlorhydria (decrease gastrin)
Hyperglycemia
What drug can decrease the symtpoms of pancreatic neuroendocrine tumors?
Octerotide
mostly for VIPomas and Gastrinomas
