60 Questions
Match the following risk factors with their association to pancreatic cancer:
Tobacco use = Thought to cause 20–25% of cases Obesity = Risk factor for pancreatic cancer Chronic pancreatitis = Associated with increased risk of pancreatic cancer Family history = Linked to increased risk of pancreatic cancer
Match the following manifestations with their association to carcinoma of the pancreas:
Obstructive jaundice = May be painless Upper abdominal pain with radiation to back = Common late manifestation Enlarged gallbladder = May be painful Weight loss and thrombophlebitis = Usually late manifestations
Match the following demographic groups with their trend in pancreatic cancer incidence:
Latina women = Rapidly rising incidence Non-Hispanic White women younger than age 55 years = Rapidly rising incidence Non-Hispanic Black women younger than age 55 years = Rapidly rising incidence Overall incidence in the United States = Expected to surpass colorectal cancer by 2040
Match the following anatomical locations with their percentage distribution of pancreatic carcinomas:
Head of the pancreas = About 75% Body and tail of the pancreas = About 25% Ampullary carcinomas = Much less common Overall pancreatic carcinomas = Account for 3% of all cancers
Match the following pancreatic cancer risk factors with their descriptions:
Newonset diabetes mellitus after age 45 = Can be an early sign of pancreatic cancer, accompanied by weight loss Family history of pancreatic cancer in a firstdegree relative = 7% of pancreatic cancer patients, compared to 0.6% of control patients Genetic mutations, including KRAS oncogene mutations = Common in pancreatic cancer Polymorphisms of genes for methylene tetrahydrofolate reductase and thymidylate synthase = Associated with pancreatic cancer
Match the following pancreatic neoplasms with their descriptions:
Pancreatic intraepithelial neoplasias = Microscopic, less than 5 mm in diameter Neuroendocrine tumors = Account for 1–2% of pancreatic neoplasms, can be functional or nonfunctional Cystic neoplasms = Less than 10% of pancreatic neoplasms, may be mistaken for pseudocysts Serous cystadenomas = Benign
Match the following clinical findings of pancreatic cancer with their descriptions:
Pain = Present in over 70% of pancreatic cancer cases, often vague, diffuse, and located in the epigastrium or left upper quadrant of the abdomen, may radiate into the back Weight loss = Accompanies newonset diabetes mellitus and can be an early sign of pancreatic cancer Hyperglycemia = Clinical finding of pancreatic cancer Jaundice = Due to biliary obstruction by a cancer in the pancreatic head
Match the imaging technique with its primary usage in pancreatic cancer diagnosis and staging:
CT = Initial diagnostic procedure, detecting a mass in 76-96% of cases MRI = Alternative to CT for imaging EUS = More sensitive than CT for detecting pancreatic cancer and determining resectability PET = Sensitive technique for detecting pancreatic cancer and metastases
Match the laboratory finding with its potential indication in pancreatic cancer diagnosis:
Mild anemia = Laboratory finding in pancreatic cancer diagnosis Glycosuria = Laboratory finding in pancreatic cancer diagnosis Hyperglycemia = Laboratory finding in pancreatic cancer diagnosis Elevated CA 19-9 levels = Laboratory finding in pancreatic cancer diagnosis
Match the staging category with its description in pancreatic cancer diagnosis and staging:
Resectable = Staging category for pancreatic cancer Borderline resectable = Staging category for pancreatic cancer Locally advanced disease = Staging category for pancreatic cancer Metastatic disease = Staging category for pancreatic cancer
Match the TNM system term with its meaning in pancreatic cancer staging:
Tis = TNM system term for staging pancreatic cancer T3 = TNM system term for staging pancreatic cancer N1 = TNM system term for staging pancreatic cancer M1 = TNM system term for staging pancreatic cancer
Match the diagnostic procedure with its role in pancreatic cancer diagnosis:
Abdominal exploration = Diagnostic procedure for cases where cytologic diagnosis cannot be made CT = Diagnostic procedure for detecting a mass in 76-96% of cases MRI = Diagnostic procedure as an alternative to CT Ultrasonography = Unreliable diagnostic procedure due to interference by intestinal gas
Match the clinical sign with its potential indication in pancreatic cancer diagnosis:
Courvoisier sign = Clinical sign that may indicate obstruction by a neoplasm 30% of patients with locally advanced disease = Percentage of patients presenting with locally advanced disease Over 50% of patients with metastatic disease = Percentage of patients presenting with metastatic disease Elevated CA 19-9 levels = Laboratory finding that may indicate pancreatic cancer
Match the pancreatic cancer treatment with the corresponding statement:
Laparoscopy = Can detect tiny peritoneal or liver metastases in patients with a localized mass in the head of the pancreas Radical pancreaticoduodenal (Whipple) resection = Indicated for cancers strictly limited to the head of the pancreas, periampullary area, and duodenum (T1, N0, M0), with a 5-year survival rate of 20-25% Adjuvant chemotherapy = Superior to no adjuvant therapy, and neoadjuvant chemotherapy with or without radiation is increasingly used to downstage patients with resectable cancer Chemoradiation = May be used for palliation of unresectable cancer confined to the pancreas, and improved response rates have been reported with FOLFIRINOX and gemcitabine and nab-paclitaxel in metastatic pancreatic cancer
Match the pancreatic cancer treatment with the corresponding statement:
Olaparib = Reported to improve progression-free survival in metastatic pancreatic cancer for patients with a BRCA1 or BRCA2 germline mutation Celiac plexus nerve block or thoracoscopic splanchnicectomy = May improve pain control Surgical resection = Treatment of choice for neuroendocrine tumors (NETs) when feasible Asymptomatic incidental pancreatic cysts = At low risk for harboring invasive carcinoma and may be monitored by imaging tests, with surgical resection indicated for specific types and sizes of cysts
Match the pancreatic cancer treatment with the corresponding statement:
Surgical biliary bypass and duodenal bypass = May be considered in certain patients Endoscopic stenting of the bile duct = Performed to relieve jaundice when resection is not feasible Immune checkpoint inhibitors and other novel agents = Being studied for the treatment of pancreatic cancer Metastatic disease = May be controlled with long-acting somatostatin analogs, interferon, chemotherapy, peptide-receptor radionuclide therapy (PRRT), and chemoembolization
Match the following pancreatic cyst management strategies with their recommendations:
Monitoring cysts by imaging tests (MRI) = Recommended, with FNA if a cyst enlarges to 3 cm and other high-risk features develop Surgical resection = Indicated for mucinous cystic neoplasms, symptomatic serous cystadenomas, solid pseudopapillary tumors, and certain cystic tumors EUS-guided ablative treatment = Being studied for potentially premalignant pancreatic cysts Annual screening with EUS and MRI = Should be considered for high-risk individuals with a family history of pancreatic cancer or genetic syndrome
Match the following pancreatic carcinoma facts with their descriptions:
Prognosis of pancreatic carcinoma = Poor, with 80-85% of patients presenting with advanced unresectable disease Effect of obesity on pancreatic cancer mortality = May adversely affect mortality Effect of metformin and statins on pancreatic cancer survival = May improve survival Resection of cancer of the pancreatic head = Feasible and results in reasonable survival in carefully selected patients
Match the following facts about tumors of the ampulla with their descriptions:
Prognosis of ampullary tumors = Better, with a reported 5-year survival rate of 20-40% after resection Referral of patients with carcinoma involving the ampulla of Vater = Should be to a specialist Feasibility of EUS-guided ablative treatment for ampullary adenomas = May be feasible, but patients must be followed for recurrence Necessity of meticulous palliative care for patients with progressing disease = Essential for patients whose disease progresses despite treatment
What is the most common neoplasm of the pancreas?
Pancreatic adenocarcinoma
Which factor is NOT identified as a risk factor for pancreatic cancer?
Hepatitis B infection
What percentage of all cancers do pancreatic carcinomas account for?
3%
By 2040, pancreatic cancer is expected to surpass which cancer as the second leading cause of cancer-related deaths in the United States?
Colorectal cancer
Which imaging technique is more sensitive than CT for detecting pancreatic cancer and determining resectability?
EUS
What is the commonly used staging system for pancreatic cancer?
TNM
What percentage of patients present with locally advanced disease?
Over 50%
What may indicate obstruction by a neoplasm, but with exceptions?
Courvoisier sign
Which imaging technique is generally the initial diagnostic procedure for detecting a mass in pancreatic cancer cases?
CT
What are the laboratory findings that may be present in pancreatic cancer?
Mild anemia, glycosuria, hyperglycemia, and elevated CA 19-9 levels
What does the TNM system include for staging pancreatic cancer?
Tumor size, number of affected lymph nodes, and metastasis status
What is the primary usage of ERCP in pancreatic cancer diagnosis and staging?
Detecting resectability
What is the alternative to CT for pancreatic cancer diagnosis?
MRI
What is a sensitive technique for detecting pancreatic cancer and metastases?
PET
What is used for pancreatic cancer diagnosis when cytologic diagnosis cannot be made?
Abdominal exploration
Why is ultrasonography unreliable for pancreatic cancer diagnosis?
Interference by intestinal gas
What is more sensitive than CT for detecting pancreatic cancer?
MRI
What is the recommended monitoring approach for pancreatic cysts?
MRI imaging and FNA if a cyst enlarges to 3 cm and other high-risk features develop
What is the reported 5-year survival rate for tumors of the ampulla after resection?
20-40%
What is the prognosis for pancreatic carcinoma?
Poor, with 80-85% of patients presenting with advanced unresectable disease
What is the recommended approach for high-risk individuals with a family history of pancreatic cancer or genetic syndrome?
Annual screening with EUS and MRI
What is the impact of obesity on mortality in pancreatic cancer?
Increased mortality
When is surgical resection indicated for pancreatic neoplasms?
For mucinous cystic neoplasms, symptomatic serous cystadenomas, solid pseudopapillary tumors, and certain cystic tumors
What is being studied for potentially premalignant pancreatic cysts?
EUS-guided ablative treatment
What is the recommended referral for patients with carcinoma involving the pancreas and the ampulla of Vater?
Referral to a specialist
What is the role of metformin and statins in pancreatic cancer?
Improve survival
What is the recommended management approach for patients whose disease progresses despite treatment?
Meticulous efforts at palliative care
What should be considered for high-risk individuals with a family history of pancreatic cancer or genetic syndrome?
Annual screening with EUS and MRI
When is EUS-guided ablative treatment feasible for ampullary adenomas?
Feasible, but patients must be followed for recurrence
What percentage of pancreatic cancer patients have a family history of the disease in a first-degree relative?
7%
What is the primary role of neuroendocrine tumors in pancreatic neoplasms?
Produce various hormones
What is a common finding in the clinical presentation of pancreatic cancer?
Pain in the epigastrium
Which genetic mutations are common in pancreatic cancer?
KRAS oncogene mutations
What percentage of pancreatic neoplasms do cystic neoplasms account for?
Less than 10%
What is a characteristic of serous cystadenomas?
Benign
What is a potential indication of jaundice in pancreatic cancer diagnosis?
Biliary obstruction
What is the most common location for pain in pancreatic cancer cases?
Epigastrium
Which syndrome is NOT included in the hereditary syndromes associated with pancreatic cancer?
Down syndrome
What is a risk factor in the risk model for pancreatic cancer in people with new-onset diabetes?
Levels of hemoglobin A1C
What is a common finding in the clinical presentation of pancreatic cancer?
Weight loss
What is the reported percentage of neuroendocrine tumors in pancreatic neoplasms?
1–2%
Study Notes
Pancreatic Carcinoma and Ampulla of Vater: Key Points
- Monitoring cysts by imaging tests (MRI) is recommended, with FNA if a cyst enlarges to 3 cm and other high-risk features develop.
- Surgical resection is indicated for mucinous cystic neoplasms, symptomatic serous cystadenomas, solid pseudopapillary tumors, and certain cystic tumors.
- EUS-guided ablative treatment for potentially premalignant pancreatic cysts is being studied.
- Pancreatic carcinoma has a poor prognosis, with 80-85% of patients presenting with advanced unresectable disease.
- Obesity may adversely affect mortality in pancreatic cancer, while metformin and statins may improve survival.
- Tumors of the ampulla have a better prognosis, with a reported 5-year survival rate of 20-40% after resection.
- Resection of cancer of the pancreatic head is feasible and results in reasonable survival in carefully selected patients.
- Annual screening with EUS and MRI should be considered for high-risk individuals with a family history of pancreatic cancer or genetic syndrome.
- All patients with carcinoma involving the pancreas and the ampulla of Vater should be referred to a specialist.
- Patients who require surgery and other interventions should be hospitalized.
- EUS-guided ablative treatment for ampullary adenomas may be feasible, but patients must be followed for recurrence.
- Meticulous efforts at palliative care are essential for patients whose disease progresses despite treatment.
Pancreatic Carcinoma and Ampulla of Vater: Key Points
- Monitoring cysts by imaging tests (MRI) is recommended, with FNA if a cyst enlarges to 3 cm and other high-risk features develop.
- Surgical resection is indicated for mucinous cystic neoplasms, symptomatic serous cystadenomas, solid pseudopapillary tumors, and certain cystic tumors.
- EUS-guided ablative treatment for potentially premalignant pancreatic cysts is being studied.
- Pancreatic carcinoma has a poor prognosis, with 80-85% of patients presenting with advanced unresectable disease.
- Obesity may adversely affect mortality in pancreatic cancer, while metformin and statins may improve survival.
- Tumors of the ampulla have a better prognosis, with a reported 5-year survival rate of 20-40% after resection.
- Resection of cancer of the pancreatic head is feasible and results in reasonable survival in carefully selected patients.
- Annual screening with EUS and MRI should be considered for high-risk individuals with a family history of pancreatic cancer or genetic syndrome.
- All patients with carcinoma involving the pancreas and the ampulla of Vater should be referred to a specialist.
- Patients who require surgery and other interventions should be hospitalized.
- EUS-guided ablative treatment for ampullary adenomas may be feasible, but patients must be followed for recurrence.
- Meticulous efforts at palliative care are essential for patients whose disease progresses despite treatment.
Understanding Pancreatic Cancer and Neoplasms
- Newonset diabetes mellitus after age 45 can be an early sign of pancreatic cancer, accompanied by weight loss.
- Factors in the risk model for pancreatic cancer in people with newonset diabetes include age, BMI, smoking, use of PPIs, diabetes medications, and levels of hemoglobin A1C, cholesterol, hemoglobin, creatinine, and alkaline phosphatase.
- 7% of pancreatic cancer patients have a family history of the disease in a firstdegree relative, compared to 0.6% of control patients.
- Genetic mutations, including KRAS oncogene mutations, inactivation of tumor suppressor genes, and DNA mismatch repair deficiency, are common in pancreatic cancer.
- Pancreatic cancers originate from pancreatic intraepithelial neoplasias, which are microscopic and measure less than 5 mm in diameter.
- 10–15% of pancreatic cancer cases occur as part of hereditary syndromes, including familial breast cancer, hereditary pancreatitis, and Lynch syndrome.
- Polymorphisms of genes for methylene tetrahydrofolate reductase and thymidylate synthase are associated with pancreatic cancer.
- Neuroendocrine tumors account for 1–2% of pancreatic neoplasms and can be functional or nonfunctional, producing various hormones.
- Cystic neoplasms account for less than 10% of pancreatic neoplasms and may be mistaken for pseudocysts.
- Clinical findings of pancreatic cancer include pain, vague and diffuse in the epigastrium, weight loss, hyperglycemia, and jaundice due to biliary obstruction by a cancer in the pancreatic head.
- Serous cystadenomas are benign, while mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, solid pseudopapillary tumors, and cystic islet cell tumors may be malignant.
- Pain is present in over 70% of pancreatic cancer cases, often vague, diffuse, and located in the epigastrium or left upper quadrant of the abdomen, and may radiate into the back.
Test your knowledge on pancreatic carcinoma and ampulla of Vater with this informative quiz. Explore key points on monitoring, treatment options, prognosis, and factors impacting survival. Ideal for medical professionals and individuals seeking to deepen their understanding of these conditions.
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