04b: Pancreatic, Hepatic Flashcards Preview

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

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

X = 12
Y = 4

2

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

X = 15-20
Y = 10-30

3

Pancreatic cancer: median survival with resection is...

20-24 months

4

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

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

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

True

6

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

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

7

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

X = 95
Exocrine
Head (60-70%)

8

Most common specific type of pancreatic tumor is:

Ductal adenocarcinoma

9

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

KRAS

10

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

X = bile duct;

Painless jaundice, abd pain, N/V

11

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

X = head/neck/body
Y = Pancreatic duct

12

Which Sx are common to ALL pancreatic cancer lesions?

Fatigue, anorexia, weight loss

13

Pancreatic cancer: preferred modality for diagnosis and staging.

Triple phase CT

14

Pancreatic cancer: most common surgical Rx

Whipple (Pancreatoduodenectomy with reconstruction)

15

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

X = 5-7

16

Patients with locally advanced pancreatic cancer are treated with:

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

17

Patients with metastatic pancreatic cancer are treated with:

Chemo (gemcitabine; modest palliative benefit)

18

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)

19

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

X = 4

20

Geographic variation of HCC primarily due to variance in:

Hep B infection

21

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

Late
X = 6-20 months

22

HCC RFs:

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

23

Universal symptoms for HCC

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

24

HCC metastatic spread is usually to:

lungs and bone

25

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)

26

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)

27

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

X = alpha-fetoprotein
Y = germ cell

28

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

X = over 500 ng/mL

29

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)

30

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

Benign;
X = pancreatitis