Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
28 Cards in this Set
- Front
- Back
|
What is the incidence of pancreatic cancer?
|
30,000 cases of exocrine pancrease/year
incidence has tripled from 1920-1978 relatively constant since 1978 |
|
|
What is the mortality of pancreatic cancer
|
most pts die w/in the year
3% of all cancer deaths in men 5% of all cancer deaths in women survival is greatest when tumor is localized to pancreas, but less than 10% of cases are detected this way 52% of all cases are diagnosised in Stage IV |
|
|
Is pancreatic cancer more common in blacks or whites?
Is it common before age 50? |
blacks
no, it is rare |
|
|
Is pancreatic cancer more common in men or women?
smokers or nonsmokers? |
males
smokers |
|
|
What are the risk factors for pancreatic cancer?
|
smoking
associated with diabetes (studies are inconsistent) possible link to history of chronic pancreatitis high-fat diet, physical inactivity, obesity suspected chemical exposure |
|
|
What are the genetic markers for pancreatic cancer?
|
k-ras (oncogene-70% of Pan.Ca)
P16 - tumor suppressor gene P53 - tumor suppressor gene BRCA2- tumor suppressor gene |
|
|
What is the distribution of ductal adenocarcinoma?
|
90% primary pancreatic cancers:
70% in head, neck or uncinate 30% in body and tail 20% entire gland |
|
|
What is the morphology of ductal adenocarcinoma?
|
white to yello
poorly defined firm mass |
|
|
What are the variants of ductal adenocarcinoma?
|
mucinous noncystic
signet ring adenosquamous anaplastic giant cell sacromatoid |
|
|
What would you see microscopically in ductal adenocarcinoma?
|
infiltrative glands surrounded by dense reactive fibrous tissue
AND invading surrounding vascular and lymphatic areas |
|
|
What are the symptoms of pancreatic cancer?
|
jaundice (obstructive in >80%)
weight loss (75%) abdominal pain (75%) weakness nausea and vomiting anorexia pruritis acute pancreatitis new onest diabetes 10% of pts muscle wasting hepatomegaly courvoiser's sign ?50%, palpable GB trousseau's sign 10% - migratory thrombophlebitis |
|
|
What are lab values?
|
elevated serum total bilirubin
alkaline phosphatase increased GGTP ALT AST hepatitis serolgy typically negative |
|
|
What is Marker CA19-9 (carbohydrate antigen)?
|
Used if suspect pancreatic cancer or in order to judge treatment.
|
|
|
What is good about CA19-9 and when shouldn't it be used?
|
86% sensitivity
87% specificity It shouldn't be used for early diagnosis High CEA may be detected |
|
|
What is the best imaging to use for pancreatic cancer?
|
CT (cheaper than MRI)
|
|
|
What are common metastatic cancer sites for pancreatic cancer?
|
liver (80% of cases)
lungs and pleura (50-70% of cases) adrenal (25% of cases) |
|
|
What can you use to evaulate the metastases of pancreatic cancer?
|
PET scan
|
|
|
When can you use EUS(endoscopic ultra sound)?
|
when diagnosing tumors right next to the gastric system
|
|
|
When can pancreatic cancer be resected?
|
absence of extrapancreatic disease
absence of direct tumor extension into SMA or Celiac axis patent SMV-portal vein confluence |
|
|
What is the surgical history of pancreatic cancer resection?
|
1909- German Kausch--periampullary cancer two stage resection
1935 - Whipple (OLDFATHER) similar procedure 1942 - successful single stage resection |
|
|
Pancreaticoduodenectomy (whipple) does what?
|
enblocks resection of pancreas, duodemun, gall bladder and part of the stomach
|
|
|
What are the two surgical treatments for pancreatic cancer?
|
pancreaticoduodenectomy
distal pancreatectomy |
|
|
What is the mortality with the whipple procedure?
|
2-4% mortality with an experienced surgeon
5yr survival rate is 10-20% median survival is 18-20 months |
|
|
What are some different palliative surgeries for pancreatic cancer?
|
obstructive jaundice
duodenal obstruction (gastrojejunostomy) celiac plexus injection (50% ethanol injected into nerves to relieve pain) |
|
|
What are the different surgeries that will help with obstructive jaundice?
|
endoscopic stenting of common bile duct
cholecystojejunostomy choledochojejunostomy |
|
|
What are other ways, besides surgical, to treat pancreatic cancer?
|
combination therapy (benefit in small GITSG study-- chemo w/ radiation increased 2yr survival rate)
chemo (variations w/5-FU and gemcitabine) ESPAC (benefit from chemo only) |
|
|
What are some neoadjuvant therapy?
|
early systemic therapy
chemoradiation decrease tumor size before surgery (15% of tumors become resectable in a small study) |
|
|
on the left
|
Which one of these is pylorus sparing?
|
