Term
| 60 yo woman presents with painless obstructive jaundice and weight loss. What is the most likely location of the obstructing mass? |
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Definition
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Term
| What are the risk factors for ductal adenocarinoma of the pancreas? |
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Definition
| >50yo; smoking, chronic pancreatitis, DM |
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Term
| What is Trousseau's syndrome? |
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Definition
| A hypercoagulable state seen with adenocarcinoma. |
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Term
| What are the signs and symptoms of pancreatic cancer? |
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Definition
| Nausea, anorexia, lumbar back pain, new-onset DM, venous thromboembolism, and painless obstructive jaundice. |
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Term
| What lab changes indicate pancreatic cancer? |
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Definition
| Increased bilirubin; increased aminotransferases, and normocytic, normochromic anemia. |
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Term
| How do you establish diagnosis of pancreatic cancer? |
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Definition
Labs: Bilirubin, LFT, CBC
ultrasound initially, then abd/pelvic CT; endoscopic ultrasound (can determine if resectable) |
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Term
| What are the treatment options for pancreatic cancer? |
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Definition
Whipple for resectable tumors.
Chemotherapy or Radiation for palliative care when not resectable. |
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Term
| What are the risk factors for Hepatocellular cancer? |
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Definition
| Viral hepatitis, alcoholic cirrhosis, aflatoxin, hemochromatosis, and alpha-1-antritrypsin deficiency. |
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Term
| What labs will you see with HCC? |
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Definition
| increased bilirubin, increased LFT, coagulopathy |
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Term
| What is the treatment for HCC? |
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Definition
Surgical resection and liver transplantation can give long-term survival.
For unresectable tumors; percutaneous alcohol inections, arterial chemoembolization, radiofrequency ablation, and chemotherapy (sorafenib) |
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Term
| A 60yo man with known colon cancer in remission is found to have a CEA level that is increased from baseline. What does this indicate? |
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Definition
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Term
| What are the symptoms of colorectal cancer? |
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Definition
| Change in bowel habits, melena, BRBPR, wt loss, fatigue, vomiting, and abdominal discomfort, iron-deficiency anemia, increased transaminases. |
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Term
| What treatments are available for colon cancer? |
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Definition
| Resection with regional lymph nodes and adjacent mesentery. |
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Term
| What can be done for solitary liver or lung mets when present with colorectal cancer? |
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Definition
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Term
| What adjuvent therapy is available for colorectal cancer stage III and above? |
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Definition
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Term
| A 65 yo man with a history of GERD presents with a 10lb weight loss, dysphagia, and epigastric pain. What will biopsy results from EGD most likely reveal? |
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Definition
| Esophageal adenocarcinoma. |
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Term
| What are the symptoms/Exam of someone with an esophageal tumor? |
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Definition
| Dysphagia, smokers and alcoholics; confirm with EGD and biopsy. |
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Term
| How do you treat esophageal cancer? |
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Definition
| Resection for localized disease and radiation therapy with chemo for advanced disease. |
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Term
| What are the characteristics of Gastric cancer? |
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Definition
| more common among asian ethnicity; presents with iron-dificiency anemia with vague abdominal pain in the elderly |
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Term
| How do you diagnose and treat gastric cancer? |
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Definition
EGD with biopsy for Ex.
Resection for localized disease and radiation therapy with chemo for advanced disease. |
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Term
| How does a carcinoid tumor present? |
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Definition
| Generally found in the appendix of small bowel. Clinically presents with flushing, abdominal pain, diarrhea and tricuspid regurgitation (syndrome) |
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Term
| How does an insulinoma present? |
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Definition
| Elevated proinsulin, C-peptide, and insulin levels. Hypoglycemia, fasting blood glucose <40 and immediate relief with glucose administration. |
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Term
| How does a VIPoma present? |
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Definition
| Elevated VIP levels, suspect in setting of profuse watery diarrhea that causes hypokalemia. |
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Term
| How does a glucogonoma present? |
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Definition
| Elevated glucagon levels. Characterized by persistent hyperglycemia with necrolytic erythema (intertriginous and perioral rash) |
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Term
| What are the three islet cell tumors? |
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Definition
| Insulinoma, VIPoma, and Glucogonoma |
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Term
| How do you diagnose islet cell tumors? |
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Definition
| Somatostatin receptor scintigraphy for localization. Mets are most commonly found in the liver. |
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Term
| What are the treatment options for islet cell tumors? |
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Definition
| Surgical resection, debulking, chemotherapy, and somatostatin analogs with glucagonomas and VIPomas. |
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