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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?
no, it is rare
Is pancreatic cancer more common in men or women?
smokers or nonsmokers?
What are the risk factors for pancreatic cancer?
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
giant cell
What would you see microscopically in ductal adenocarcinoma?
infiltrative glands surrounded by dense reactive fibrous tissue
invading surrounding vascular and lymphatic areas
What are the symptoms of pancreatic cancer?
jaundice (obstructive in >80%)
weight loss (75%)
abdominal pain (75%)
nausea and vomiting
acute pancreatitis
new onest diabetes 10% of pts
muscle wasting
courvoiser's sign ?50%, palpable GB
trousseau's sign 10% - migratory thrombophlebitis
What are lab values?
elevated serum total bilirubin
alkaline phosphatase
increased GGTP
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?
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
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
decrease tumor size before surgery (15% of tumors become resectable in a small study)
on the left
Which one of these is pylorus sparing?