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)
Most cysts of pancreas are (benign/malignant), caused by (X).
X = pancreatitis
(X) pancreatic cysts are 20x more common in women than in men and are (benign/malignant).
X = mucinous cystic neoplasms
Can be benign, borderline, or malignant (MUST be resected and examined for carcinoma)
(X) pancreatic cysts are always benign neoplasms composed of (Y) cells that line small lobules filled with (Z).
X = serous cystadenomas
Y = glycogen-rich low-cuboidal
Z = thin, clear, straw-colored fluid
(X) pancreatic cyst can be distinguished from mucinous cystic neoplasms by which two features?
X = intraductal papillary mucinous neoplasm (IPMN)
1. No "ovarian" stroma
2. Located in main pancreatic duct
T/F: Pancreatic endocrine neoplasms are always malignant.
False - can also be benign
List the criteria that definitively diagnose a pancreatic endocrine neoplasm as malignant:
1. Metastases (lymph nodes or beyond)
2. Vascular invasion
3. Invasion of adjacent viscera
T/F: 90% of insulinomas are benign.
Most common pancreatic endocrine neoplasm
Beta cell tumor (insulinoma)
(X) pancreatic endocrine neoplasm is usually invasive/metastatic, with 25% of cases arising in conjunction with other endocrine tumors due to (Y) syndrome.
X = ZES (gastrinoma)
Y = MEN1 (multiple endocrine neoplasia)