04b: Pancreatic, Hepatic Flashcards Preview

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Flashcards in 04b: Pancreatic, Hepatic Deck (39)
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1
Q

Pancreatic cancer is number (X) on list of common cancers and number (Y) on list of cancer death causes.

A
X = 12
Y = 4
2
Q

Pancreatic cancer: (X)% of patients have potentially curable/resectable lesions. Of these, (Y)% achieve 5y survival.

A
X = 15-20
Y = 10-30
3
Q

Pancreatic cancer: median survival with resection is…

A

20-24 months

4
Q

List the Pancreatic cancer RFs. Star the best-established factor.

A
  1. Age, M, AA
  2. Chronic or hereditary Pancreatitis
  3. Smoking*
  4. High meat/fat diet; DM
  5. Genetics (BRCA2/1, Lynch, Peutz-Jeghers)
5
Q

T/F: 40% of patients with hereditary pancreatitis will develop pancreatic cancer by age 70.

A

True

6
Q

T/F: Screening for pancreatic cancer has proven overall nonbenefical.

A

False - rarely indicated, but benefit seen for pts with hereditary pancreatitis

7
Q

Most, (X)%, of pancreatic cancers are (exo/endo)-crine and located at (head/tail) of pancreas.

A

X = 95
Exocrine
Head (60-70%)

8
Q

Most common specific type of pancreatic tumor is:

A

Ductal adenocarcinoma

9
Q

Which common mutation is found in up to 90% of pancreatic tumors?

A

KRAS

10
Q

Pancreatic cancer: list Sx associated with head/neck lesion that obstructs (X).

A

X = bile duct;

Painless jaundice, abd pain, N/V

11
Q

Pacnreatic cancer: Sx of pancreatitis, abdominal/back pain indicative of mass in (X) location, obstructing (Y).

A
X = head/neck/body
Y = Pancreatic duct
12
Q

Which Sx are common to ALL pancreatic cancer lesions?

A

Fatigue, anorexia, weight loss

13
Q

Pancreatic cancer: preferred modality for diagnosis and staging.

A

Triple phase CT

14
Q

Pancreatic cancer: most common surgical Rx

A

Whipple (Pancreatoduodenectomy with reconstruction)

15
Q

Overall, (X)% of patients diagnosed with pancreatic cancer are alive after 5 years.

A

X = 5-7

16
Q

Patients with locally advanced pancreatic cancer are treated with:

A

Chemo (5FU)/radiation (palliative and small survival benefit)

17
Q

Patients with metastatic pancreatic cancer are treated with:

A

Chemo (gemcitabine; modest palliative benefit)

18
Q

Pancreatic cancer: what are two procedures that can be done for palliative care?

A
  1. ERCP with CBD stenting (relieve pain/jaundice)

2. Neurolysis of celiac plexus (EUS-guided alcohol injection)

19
Q

Hepatocellular carcinoma (HCC) is number (X) on list of worldwide causes of cancer death.

A

X = 4

20
Q

Geographic variation of HCC primarily due to variance in:

A

Hep B infection

21
Q

HCC often diagnosed (early/late) with median survival of (X) at diagnosis.

A

Late

X = 6-20 months

22
Q

HCC RFs:

A
  1. Male (4:1)
  2. Viral hepatitis (B/C)
  3. Cirrhosis
  4. Aflatoxin
23
Q

Universal symptoms for HCC

A

There are none.. usually asymptomatic; maybe weight loss, ascites, palpable mass, jaundice?

24
Q

HCC metastatic spread is usually to:

A

lungs and bone

25
Q

Who should be screened for HCC?

A
  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)

26
Q

HCC screening done how often? Using which methods? Star the most reliable/accurate one.

A

6 month intervals;

  1. RUQ ultrasound*
  2. Serum alpha-fetoprotein (AFP)
27
Q

HCC: serum (X) levels used for screening with moderate specificity, since (Y) tumors can also secrete (X).

A
X = alpha-fetoprotein
Y = germ cell
28
Q

HCC: alpha-fetoprotein level of (X) is essentially diagnostic

A

X = over 500 ng/mL

29
Q

HCC: if screening test abnormal, what’s the next step?

A

Obtain 3-phase CT or contrast-enhanced MRI to confirm diagnosis (no need to biopsy)

30
Q

Most cysts of pancreas are (benign/malignant), caused by (X).

A

Benign;

X = pancreatitis

31
Q

(X) pancreatic cysts are 20x more common in women than in men and are (benign/malignant).

A

X = mucinous cystic neoplasms

Can be benign, borderline, or malignant (MUST be resected and examined for carcinoma)

32
Q

(X) pancreatic cysts are always benign neoplasms composed of (Y) cells that line small lobules filled with (Z).

A
X = serous cystadenomas
Y = glycogen-rich low-cuboidal 
Z = thin, clear, straw-colored fluid
33
Q

(X) pancreatic cyst can be distinguished from mucinous cystic neoplasms by which two features?

A

X = intraductal papillary mucinous neoplasm (IPMN)

  1. No “ovarian” stroma
  2. Located in main pancreatic duct
34
Q

T/F: Pancreatic endocrine neoplasms are always malignant.

A

False - can also be benign

35
Q

List the criteria that definitively diagnose a pancreatic endocrine neoplasm as malignant:

A
  1. Metastases (lymph nodes or beyond)
  2. Vascular invasion
  3. Invasion of adjacent viscera
36
Q

T/F: 90% of insulinomas are benign.

A

True

37
Q

Most common pancreatic endocrine neoplasm

A

Beta cell tumor (insulinoma)

38
Q

(X) pancreatic endocrine neoplasm is usually invasive/metastatic, with 25% of cases arising in conjunction with other endocrine tumors due to (Y) syndrome.

A
X = ZES (gastrinoma)
Y = MEN1 (multiple endocrine neoplasia)
39
Q

Inactivation of which tumor suppressor genes is seen in most pancreatic carcinomas?

A
  1. p16 (95% of cases)
  2. SMAD4 (50%)
  3. p53 (75%)