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27 Cards in this Set
- Front
- Back
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What is the most common pancreatic carcinoma?
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adenocarcinoma of the pancreas arising from duct cells
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What are risk factors associated with pancreatic adenocarcinoma?
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smoking = 3x risk
diabetes mellitus heavy alcohol use chronic pancreatitis coffee exposure to chemicals (benzidine, beta naphthylamine) |
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What is male:female ratio in pancreatic carcinoma? Avg age?
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3:2
60+ yrs |
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What are the different types of pancreatic carcinoma?
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90%+ are duct cell adenocarcinomas
others: cystadenocarcinoma, acinar cell carcinoma |
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What is distribution of pancreatic carcinoma?
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2/3 in pancreatic head
1/3 in body and tail |
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Why are pancreatic head cancers caught earlier?
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they cause symptoms due to biliary obstruction; tail cancers are not caught until too late
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What are signs and symptoms of pancreatic head cancer?
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painless jaundice (obtruction of common bile duct)
weight loss abdominal pain weakness pruritis (bile salts in skin) anorexia palpable, nontender, distended gallbladder (Courvoisier's Sign) acholic stools dark urine |
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What % of pancreatic carcinoma pts will have Courvoisier's Sign?
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33%
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What is the classic presentation of pancreatic cancer in the head of the pancreas?
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painless jaundice
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What are the signs and sx associated with cancer in pancreatic body or tail?
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weight loss and pain
migratory thrombophlebitis jaundice nausea and vomiting fatigue |
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What are the lab findings in pancreatic carcinoma?
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increased Dbili and alk phos (biliary obstruction)
increased LFTs elevated pancreatic tumor cell markers |
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What are the diagnostic studies to explore pancreatic cancer?
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abdominal CT
u/s cholangiography (ERCP to rule out choledocholithiasis and cell brushings) |
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What is the treatment for carcinoma in the head of the pancreas?
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Whipple procedure
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What are contraindications for surgery?
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vascular encasement (portal vein, SMV, SMA)
liver mets peritoneal implants distant lymph note mets (periaortic/celiac nodes) distant mets |
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What is the Whipple procedure?
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cholecystectomy
truncal vagotomy antrectomy pancreaticoduodenectomy choledochojejunostomy pancreaticojejunostomy gastrojejunostomy |
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Complication rate after Whipple procedure?
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25%
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What is mortality rate in a Whipple procedure?
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3%
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What is the "pylorus-preserving Whipple"?
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no antrectomy
anastomose duodenum to jejunum |
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What are possible post-Whipple complications?
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delayed gastric emptying (with antrectomy)
anastomotic leak causing pancreatic/biliary fistula wound infection sepsis pancreatitis postgastrectomy syndromes |
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Why remove the duodenum if pancreatic head is removed?
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share same blood supply
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What is the pre-op and post-op adjuvant therapy for Whipple procedures?
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chemotherapy (5-FU) and x-ray therapy
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What is survival rate for resection at 5 years?
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20%
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What is prognosis at 1yr after diagnosis of pancreatic carcinoma?
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90% of pts die within 1 year of diagnosis
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Is the pancreas retroperitoneal?
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All but the tail is.
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What is the Duct of Wirsung?
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The duct which collects the pancreatic enzymes to flow into the duodenum
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Blood supply to the pancreatic head?
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pancreaticoduodenal
[aorta - celiac - common hepatic - gastroduodenal - anterior superior and posterior superior pancreaticoduodenal] [aorta - superior mesenteric - inferior pancreaticoduodenal] |
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Blood supply to the pancreatic body and tail?
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[aorta - celiac - splenic]
[aorta - superior mesenteric - direct pancreatic branches] |
