Flashcards in 04b: Pancreatic, Hepatic Deck (39)
Pancreatic cancer is number (X) on list of common cancers and number (Y) on list of cancer death causes.
X = 12
Y = 4
Pancreatic cancer: (X)% of patients have potentially curable/resectable lesions. Of these, (Y)% achieve 5y survival.
X = 15-20
Y = 10-30
Pancreatic cancer: median survival with resection is...
List the Pancreatic cancer RFs. Star the best-established factor.
1. Age, M, AA
2. Chronic or hereditary Pancreatitis
4. High meat/fat diet; DM
5. Genetics (BRCA2/1, Lynch, Peutz-Jeghers)
T/F: 40% of patients with hereditary pancreatitis will develop pancreatic cancer by age 70.
T/F: Screening for pancreatic cancer has proven overall nonbenefical.
False - rarely indicated, but benefit seen for pts with hereditary pancreatitis
Most, (X)%, of pancreatic cancers are (exo/endo)-crine and located at (head/tail) of pancreas.
X = 95
Most common specific type of pancreatic tumor is:
Which common mutation is found in up to 90% of pancreatic tumors?
Pancreatic cancer: list Sx associated with head/neck lesion that obstructs (X).
X = bile duct;
Painless jaundice, abd pain, N/V
Pacnreatic cancer: Sx of pancreatitis, abdominal/back pain indicative of mass in (X) location, obstructing (Y).
X = head/neck/body
Y = Pancreatic duct
Which Sx are common to ALL pancreatic cancer lesions?
Fatigue, anorexia, weight loss
Pancreatic cancer: preferred modality for diagnosis and staging.
Triple phase CT
Pancreatic cancer: most common surgical Rx
Whipple (Pancreatoduodenectomy with reconstruction)
Overall, (X)% of patients diagnosed with pancreatic cancer are alive after 5 years.
X = 5-7
Patients with locally advanced pancreatic cancer are treated with:
Chemo (5FU)/radiation (palliative and small survival benefit)
Patients with metastatic pancreatic cancer are treated with:
Chemo (gemcitabine; modest palliative benefit)
Pancreatic cancer: what are two procedures that can be done for palliative care?
1. ERCP with CBD stenting (relieve pain/jaundice)
2. Neurolysis of celiac plexus (EUS-guided alcohol injection)
Hepatocellular carcinoma (HCC) is number (X) on list of worldwide causes of cancer death.
X = 4
Geographic variation of HCC primarily due to variance in:
Hep B infection
HCC often diagnosed (early/late) with median survival of (X) at diagnosis.
X = 6-20 months
1. Male (4:1)
2. Viral hepatitis (B/C)
Universal symptoms for HCC
There are none.. usually asymptomatic; maybe weight loss, ascites, palpable mass, jaundice?
HCC metastatic spread is usually to:
lungs and bone
Who should be screened for HCC?
1. Cirrhosis (of any etiology)
2. HBV pts (Asian M over 40 or F over 50, AA over 20, FHx of HCC, high viral load/ALT)
HCC screening done how often? Using which methods? Star the most reliable/accurate one.
6 month intervals;
1. RUQ ultrasound*
2. Serum alpha-fetoprotein (AFP)
HCC: serum (X) levels used for screening with moderate specificity, since (Y) tumors can also secrete (X).
X = alpha-fetoprotein
Y = germ cell
HCC: alpha-fetoprotein level of (X) is essentially diagnostic
X = over 500 ng/mL
HCC: if screening test abnormal, what's the next step?
Obtain 3-phase CT or contrast-enhanced MRI to confirm diagnosis (no need to biopsy)