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Flashcards in Pancreatic Malignancies Deck (29)
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1
Q

What are the two types of pancreatic cancer?

A
Ductal adenocarcinoma (85%)
Intraductal Pancreatic Mucinous Neoplasm (2-3%)
2
Q

What are some risk factors for the development of exocrine pancreatic cancer?

A
Cigarette smoking (1.5x increased relative risk)
Chronic pancreatitis (1.8% at 10 years, 4% at 20 years)
3
Q

What are some genetic changes that lead to the development of pancreatic cancer?

A

Mutations of K-RAS
Inactivation of p16
Inactivation of p53, SMAD4, BRCA2

4
Q

How do patients with pancreatic cancer typically present?

A

weakness, weight loss, anorexia, abdominal pain, jaundice, back pain

5
Q

What clinical symptoms are more common for cancers in the pancreatic head?

A

Painless jaundice
Steatorrhea
Weight loss

6
Q

How do you diagnosis pancreatic cancer?

A

Cholestatic liver pattern if biliary obstruction is present
Abdominal ultrasound for patients with jaundice
CT for patients with abdominal pain and weight loss (staging information too)

7
Q

Is carbonic anhydrase a helpful lab test for determining whether a patient has pancreatic cancer?

A

Not really – increased values may help you differentiation benign from cancer but values are often normal in early stages

8
Q

What is the treatment for pancreatic cancer?

A

Surgical resection – but 80-85% are unresectable at time of diagnosis because of distant metastases (liver) or invasion or encasement of the major blood vessels

Neoadjuvant therapy (before surgery) -- converts patient from nonresectable to resectable
Adjuvent therapy (after surgery ) -- patients with residual disease
Palliative -- surgical bypass for gastric outlet or biliary obstruction; stents: biliary, enteral
9
Q

What are some types of pancreatic cystic neoplasms?

A

Mucinous neoplasms = mucinous cystic neoplasma, Intraductal papillary mucinous neoplasm (IPMN)
Non-mucinous neoplasms = serous cystadenoma

10
Q

Who gets mucinous cystic neoplasms?

A

95% occur in women

Typically diagnosed > 40 yo

11
Q

What is a mucinous cystic neoplasm?

A

Ovarian-like storm that secretes mucin
Typically present in pancreatic body or tail
No communication with the pancreatic duct

12
Q

What are some symptoms of mucinous cystic neoplasm?

A

Usually asymptomatic
When symptomatic, can present with abdominal pain, recurrent pancreatitis, gastric outlet obstruction, palpable mass
Jaundice or weight loss more common with malignancy

13
Q

What is the treatment for mucinous cystic neoplasm?

A

Surgical resection regardless of size, d/t risk of malignancy

14
Q

What is an intraductal papillary mucinous neoplasm (IPMN)?

A

Mucin-producing papillary neoplasm of pancreatic duct

No predilection for location

15
Q

What are the different types of IPMN?

A

Main duct IPMN: involves the main pancreatic duct
Branch duct IPMN: involves the side branches of the main pancreatic duct
Mixed type IPMN: involves both the main pancreatic duct and its side branches

16
Q

What are some symptoms with IPMN?

A

Usually asymptomatic
Chronic pancreatitis d/t obstruction of pancreatic duct from mucous plugs
Back pain, jaundice, weight loss, anorexia, DM, anorexia concerning for malignancy

17
Q

What is the management for IPMN?

A

Main duct: surgical resection d/t risk of malignancy (70%)

Side branch: lower risk of malignancy, safe to monitor under 3cm, no pancreatitis

18
Q

What is a serous cyst adenoma?

A
25% of pancreatic cystic neoplasms 
Lined by glycogen-rich cells originating from pancreatic acinar cells 
Can arise anywhere in the pancreas
Usually in women over the age of 60 
Malignancy rare
*Central scar
19
Q

What are some symptoms of a serous cystadenoma?

A

Usually asymptomatic

Can present with abdominal pain, palpable mass, biliary obstruction, or gastric outlet obstruction when large

20
Q

How do you manage serous cystadenomas?

A

Conservative

Surgical resection if symptomatic

21
Q

What do you use to determine if a lesion is mucinous vs serous?

A

Endoscopic ultrasound/fine needle aspirate to sample cytology

22
Q

Name some examples of pancreatic neuroendocrine tumors.

A
Gastrinomas
Insulinomas
Somatostainomas
Glucagonomas
VIPomas
23
Q

How does insulinoma present?

A

Episodic hypoglycemia, most common pancreatic NET

24
Q

How does glucagonoma present?

A

Hyperglycemia, rash (necrolytic migratory erythema), chelitis, venous thrombosis

25
Q

How does a somatostatinoma present?

A

Diabetes mellitus (gastric inhibitory peptide), cholelithiasis (CCK), steatorrhea (secretin)

26
Q

How does VIPoma present?

A

Pancreatic cholera = watery diarrhea, hypokalemia, achlorhydria (WHDA)
VIP stimulates secretion of water into pancreatic juice and bile, inhibits gastric acid secretion

27
Q

What are some ways to diagnose NET?

A
Imaging: CT, MRI, Endoscopic ultrasound, somatostatin-receptor scintigraphy (high levels of somatostatin receptors)
Somatostatin analogues (octreotide) decrease secretion of a broad range of hormones
Proton-pump inhibitors for gastrinomas
28
Q

What is the treatment for NETs?

A

Surgical resection of primary tumor and/or metastases

*Metastatic disease present frequently for glucagonomas (50-100%), somatostatinomas (75%), and VIPomas (60-80%)

29
Q

What is the prognosis for NETs?

A

Well differentiated pancreatic NET are generally indolent

Poorly differentiated pancreatic NET have rapid progression