Pancreatic cancer

Highest risk of pancreatic cancer is seen in

A. Hereditary pancreatitis
B. Cigarette smoking
C. Chronic pancreatitis
D. Two first-degree relatives with pancreas cancer

Extremely poor prognosis is seen in pancreatic cancer type

A. Signet ring cell carcinoma
B. Anaplastic carcinoma
C. Medullary carcinoma
D. Colloid/mucinous carcinoma

All are true of PanIN except

A. May cause localized pancreatitis
B. These are non-invasive microscopic lesion in the small pancreatic ducts
C. Variant of mucinous cyst neoplasms
D. Precursor of pancreatic adenocarcinoma

All are true of pancreatic cancer screening except

A. Population-based screening for this tumor is not recommended
B. If a non-suspicious cyst is found, surveillance should be repeated every 6-12 months
C. Solid lesions, not meeting the criteria need followup every 6 months
D. Main pancreatic duct strictures should have repeat imaging after three months

Not true regarding diagnosis of pancreatic cancer is

A. Endoscopic ultrasound (EUS) has a higher sensitivity for identifying solid pancreatic lesions, less than 2cm
B. Serum cancer antigen 19-9 (CA 19-9) is a reliable biomarker for early diagnosis
C. Cell free DNA in systemic circulation is a promising screening or diagnostic test
D. Secretin enhanced magnetic resonance imaging (MRI) can be used as a one-time screening modality

All are true regarding surgical resection in pancreatic cancer except

A. For tumors of the body and tail, distal pancreatectomy with splenectomy is the standard.
B. For a tumor of the pancreatic head or the ampulla, a pylorus-preserving pancreatoduodenectomy (PPPD) is the best
C. Total pancreatectomy is suggested in situations where one is dealing with a single large tumor
D. Whipple procedure is now reserved for situations in which the entire duodenum has to be removed

In short

Ductal adenocarcinomas

Ductal adenocarcinomas arise most commonly in the head of the gland.
Intraductal papillary mucinous neoplasms (IPMNs) are more common in the pancreatic head and in older men.


Pancreatoduodenectomy is advised in selected patients with high grade dysplasia in patients with familial adenomatous polyposis (FAP) with multiple duodenal polyps.

ERCP and biliary stenting

ERCP and biliary stenting should be carried out if there is any suggestion of cholangitis.

EUS is useful if CT fails to demonstrate a tumor

EUS is useful if CT fails to demonstrate a tumor, if tissue diagnosis is required prior to surgery.

Chemotherapy agent of choice

Gemcitabine is the chemotherapy agent of choice when compared to 5-fluorouracil in pancreatic cancer.

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