Oncology Quiz #2 (Pancreatic & Breast Cancer) – Flashcards
Unlock all answers in this set
Unlock answersquestion
Why does pancreatic cancer deserve special attention?
answer
because it's the third most common malignancy of cancer of the GIT, and the 5th leading cause of cancer death with an overall 5 year survival rate of less than 5%
question
(T/F) Most of pancreatic cancers arise from the exocrine portion
answer
True, mainly exocrine
question
(T/F) The majority of pancreatic carcinomas occur within the head or neck of the pancreas
answer
True (75%)
question
(T/F) CA19-9 is a useful marker for early pancreatic cancer
answer
False
question
(T/F) DVT can be the presentation of pancreatic cancer
answer
True
question
(T/F) CA19-9 can be used as a screening test
answer
False
question
(T/F) Smoking is the most common environmental risk factor for pancreatic carcinoma
answer
True
question
(T/F) Pancreatic cancer is inherently sensitive to chemotherapy
answer
False
question
Cite 3 inherited disorders that increase the risk of pancreatic cancer:
answer
- hereditary pancreatitis - hereditary non-polyposis colorectal cancer - multiple endocrine neoplasia
question
Is there a link between pancreatic cancer and any other type of cancer?
answer
- skin cancer - BRCA-1 gene
question
Cite 2 medical conditions associated with a high risk of cancer:
answer
- Diabetes mellitus T2 - hereditary chronic pancreatitis
question
How are diabetes, hereditary chronic pancreatitis and pancreatic cancer linked together?
answer
the common risk factors that cause them like smoking and inherited gene mutation
question
Why is pancreatic cancer called ?
answer
because it typically doesn't cause symptoms in the early stages
question
Why is pancreatic cancer hard to detect (2 reasons)?
answer
- the symptoms are so vague and usually ignored - the cancer may grow and spread for some time before symptoms develop
question
Cite 3 symptoms suggestive of cancer of the head of the pancreas?
answer
- epigastric pain - weight loss - jaundice
question
Cite the cause of jaundice:
answer
caused by the accumulation of bilirubin in the tissue and blood when there is blockage in the bile duct which prevents bile from reaching the intestine
question
What is the significance of high amylase and lipase in case of pancreatic cancer?
answer
amylase and lipase are infrequently elevated in pancreatic carcinoma unless the patient is presenting with acute pancreatitis secondary to the pancreatic cancer
question
Origin and extension of the tumor: - pancreatic cancers can arise from both the endocrine cells and the exocrine cells ...
answer
- more than 90% : adenocarcinoma of ductal origin - 5% : endocrine tumors arising from islets - 5% : acinar cell tumors
question
What is the main symptom of cancer of the body and tail of the pancreas?
answer
pain
question
Describe the site of the pain in pancreatic cancer:
answer
pain in the left upper quadrant of abdomen
question
What are the characteristics of the pain in pancreatic cancer:
answer
- constipation due to colonic involvement, then the pain increases in severity over time, it is constant or intermittent pain - the pain improves when the patient leans forward
question
What indicates retroperitoneal invasion (tumor which spreads to the adjacent nerve network that surrounds the pancreas) It is a predictor of ______________________
answer
- back pain - an unresectable tumor
question
Cite 3 positive findings that a doctor can find on examination of a patient suffering from cancer of the pancreas:
answer
- jaundice - hepatomegaly - ascites Mets to: - left supraclavicular lymph nodes - periumbilical node
question
How far is CT scan useful for pancreatic cancer?
answer
- it can detect 70-80% of pancreatice carcinomas BUT 40-50% of tumors smaller than 3cm are missed and they are the ones that could be removed - could be used to direct fine needle aspiration of pancreatic...
question
What is the mainstay of initial diagnostic modalities used for assessing patients suspected to have pancreatic carcinoma?
answer
abdominal CT scanning: multiphase contrast-enhanced CT scanning
question
Cite the advantage of spiral or helical scanner:
answer
reduction og scanning time and more accurate
question
MRI/MRCP = Magnetic resonance cholangiopancreatography = it uses a powerful magnetic field, electromagnetic waves and a computer to evaluate the liver, gallbladder, bile ducts, pancreas and pancreatic duct. What are it's advantages?
answer
- it is non-invasive and it doesn't useionizing radiation
question
Define :
answer
clean fat planes around hepatic artery, celiac axis, or superior mesenteric artery; no involvement or encasement of portal vein or SMV
question
Cite 2 advantages of EUS (endoscopic ultrasonography):
answer
- has detection rates of 99-100% for all pancreatic carcinomas, including those smaller than 3cm - when guided FNAC, it allows for simultaneous cytologic confirmation of pancreatic carcinoma at time of EUS diagnosis
question
Cite 2 disadvantages of ERCP (endoscopic retrograde cholangiopancreatography):
answer
- the changes observed aren't allways specific for pancreatic carcinoma and can be hard to differentiation from patients with chronic pancreatitis - it is more invasive and also carries 5-10% risk of significant complications with procedure
question
In the list below, choose 2 most accurate techniques used to diagnose pancreatic cancer: - CA-19 - Multiphase contrast-enhanced CT scan - ERCP - EUS
answer
- multiphace contrast-enhanced CT scan - EUS
question
Write short notes on helical CT scan and its advantage:
answer
is new and involves continuous movement of the patient through the scanner with the ability to scan faster and with higher definition of internal structure. More accurate and saves time
question
Write short notes about Grading of pancreatic cancer:
answer
- it indicates how quickly/slowly cancer cells grow Grade 1 = cells look most like normal tissue, is well differentiated ; low grade Grade 2 = cells look somewhat like normal tissue, is moderatly differentiated ; moderate grade Grade 3 = cells appear very abnormal and likelt to grow fast and spread, is poorly differentiated and high grade
question
Treatment of pancreatic cancer depends on certain factors:
answer
- type of tumor - size of tumor - extent of tumor - patient's age and general health
question
What is the standard surgical approach for operable pancreatic cancer of the head? And what is the major side effect of this surgery?
answer
pancreatoduodenectomy (whipple procedure), last 6-7 hours long. It removes pancreas, antrum of stomach, duodenum, and intrahepatic bile ducts - weight loss
question
Cite 2 chemotherapy agents which may help with pancreatic cancer:
answer
- 5-FU - Gemzar
question
Cite a new combincation of chemo and its advantage for pancreatic cancer?
answer
- Folfirinox - better survival time in advanced pancreatic cancer than Gemzar alone
question
Cite 3 side effects of chemotherapy:
answer
- lowered resistance to infection - lack of energy - loss of appetite
question
Cite 3 side effects of radiotherapy:
answer
- fatigue - skin reactions: redness and dryness to treated area - nausea and vomitting
question
Whipple surgery / cite the parts resected and the 3 anastomoses performed:
answer
- removal of: pancreas, antrum of stomach, duodenum, intrahepatic bile ducts - pancreaticojejunostomy - hepaticojejunostomy - duodenojejunostomy
question
Define NETS:
answer
heterogenous group of neoplasms composed of pancreatic neuroendocrine tumors (pNET) and carcinoid tumors
question
How are NETs classified?
answer
- functional tumors make one or more hormones that cause symptoms - non-functional tumors make substances that don't cause symptoms, symptoms are caused as tumor (malignant) spreads and grows
question
Cite the name of an NET that produces or causes: - vasoactive intestinal peptide - somatostatin - paroxysmal attacks of hypertension - gall stones - hypoglycemia
answer
- vipomas (verner-morrison syndrome) - somatostatinomas - pheochromocytoma - somatostatinomas - insulinoma
question
Cite the importance of Ki-67?
answer
is a cellular marker for proliferation and is used for grading. the more the tumor is active, the more the Ki-67 is high
question
Cite the lines of treatment of NET:
answer
- systemic chemo - targeted therapies - liver directed therapies
question
Women are considered to be at higher risk as compared to average women if there is combination of the most imortant risk factors. What are these factors?
answer
- family history - parity ; hormones - a biopsy showing proliferative changes
question
(T/F) Mammography is more sensitive and specific in younger postmenopausal than in older postmenopausal women
answer
False
question
(T/F) Mammography should always be required for the diseased side
answer
False (bilateral)
question
(T/F) Mammography is used as a screening test
answer
True
question
Breast carcinoma spreads via:
answer
- direct spread - blood - lymphatic
question
Breast cancer has a preference for certain organs or systems:
answer
- skeletal system - lungs - liver - brain
question
Explain how age is an important factor in the doctor's decision: - in girls and young women - Between 30-40 years - if the patient is menopausal
answer
- fibroadenomas - cystic disease becomes increasingly frequent so that a wait and see policy (for 1-3 months only) may be legitimate - there is no justification for waiting since the risk that a lump is cancer rises to 90% or more for patients over 60
question
Cite 2 warning signs that a careful examination of the breast could reveal?
answer
- unusual bleeding - change in size of breast - peau d'orange
question
Clinical significance - of bloody secretion from a nipple - eczematoid patch around the nipple
answer
- intraduct papilloma of breast - Paget's carcinoma
question
What is the most certain diagnostic examination of breast cancers?
answer
- biopsy (excision)
question
Short notes on Paget's carcinoma: it constitutes a peculiar evolution of an intraductal noninfiltrating carcinoma, which spreads very slowly: What is its treatment?
answer
- the epidermis of the nipple - the areola - surrounding skin (fissured, ulcerating, oozing) - later on it behaves as an invasice breast carcinoma - tx: mastectomy
question
Explain the frequent dissemination to the skeleton by malignant breast cancer cells in the absence of lung metastases:
answer
the tumor cells may spread via the paravertebral venous plexus, direct connection with the breast through the intercostal vessels
question
Short notes on HER2: HER2 gene, HER2 protein, overexpression
answer
- HER2 gene: is part of a family of genes that play roles in regulating cell growth. It creates HER2 proteins - HER2 protein: act as receptors on breast cells and promote breast cell growth - Overexpression: abnormally high number of HER2 genes per cell
question
What is the harm of getting HER2 and breast cancer?
answer
- faster growing - more aggressive
question
Why inflammatory carcinoma deserves special attention?
answer
- early and rapid spread through the lymph vessels causing skin changes (brawny induration, peau d'orange) and looks like a bacterial infection, which it isn't - because they are very aggressive
question
Cite 2 valuable indications to perform a test for BRCA gene:
answer
- women who have history of breast cancer in family - if another member has tested positive for mutations in BRCA gene
question
What does a negative test for the BrCA gene mean?
answer
means their risk of cancer is probably the same as that of people in the general population
question
Define BrCA gene:
answer
responsible for controlling cell growth in body by preventing cells from growing and dividing too fast or in an uncontrolled way
question
Significance of a positive test of BrCA gene:
answer
person has inherited a known harmful mutation
question
Cite 2 measures used as a surveillance for breast cancer:
answer
- mammography - prophylactic mastectomy
question
Cite 2 techniques used as a surveillance for cancer ovary:
answer
- CA-125 antigen blood test - Transvaginal ultrasound
question
Does prophylactic mastectomy offer a guarantee against the development of breast cancer?
answer
no, because not all at risk tissue can be removed by these procedures
