Pancreatic cancer

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Pancreatic cancer

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USMLE® Step 1 style questions USMLE

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A 57-year-old man comes to his primary care physician for evaluation of abdominal pain and fatigue. His symptoms began 4 months ago and have progressively worsened. In addition, he reports a 5 kg (11 lb) unintentional weight loss since symptom onset. The patient often wakes up at night drenched in sweat. Past medical history is notable for peripheral vascular disease and alcohol use disorder. The patient has a 40-pack-year smoking history. Physical examination shows jaundice and scleral icterus. Abdominal pain is most prominent in the epigastric region. Laboratory testing reveals the following findings:  
 
Laboratory value  Result
 Total bilirubin  5.2 mg/dL 
 Conjugated bilirubin  4.6 mg/dL 
 Alkaline phosphatase  96 U/L 
 Aspartate transaminase  110 U/L 
 Alanine transaminase  112 U/L 
 Lipase*  95 U/L 
*Normal range: 12-70 U/L   

Which of the following additional findings will be most likely present on this patient’s physical examination?  

External References

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Abdominal pain

pancreatic cancer p. 404

Anorexia

pancreatic adenocarcinoma p. 405

Chemotherapy

pancreatic cancer p. 404

Courvoisier sign

pancreatic cancer p. 404

Diabetes mellitus p. 350-358

pancreatic cancer p. 402

Jaundice p. 400

pancreatic cancer p. 402

Pancreatic cancer p. 402

5-fluorouracil for p. 444

adenocarcinomas p. 404

biliary cirrhosis and p. 402

carcinogens causing p. 221

hyperbilirubinemia with p. 400

metastases of p. 222

oncogenes and p. 220

paraneoplastic syndromes with p. 219

presentation p. 723

tumor suppressor genes and p. 220

Radiation therapy

pancreatic cancer p. 404

Smoking

pancreatic cancer and p. 404

Thrombophlebitis

pancreatic cancer p. 404

Trousseau syndrome

pancreatic cancer p. 404

Weight loss

pancreatic cancer p. 404

Whipple procedure

for pancreatic cancer p. 404

Transcript

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Pancreatic carcinoma describes the pancreas having cancerous cells arise.

Now a healthy pancreas has two types of glands, exocrine glands which sends digestive enzymes off to the small intestine, and endocrine glands which help regulate metabolism in the body, for example, maintaining normal blood sugar.

Over 95% of pancreatic tumors develop in the pancreas’s exocrine tissues, and of these, tumors arising in the epithelial cells lining the pancreatic ducts account for the vast majority of cases.

This type of pancreatic cancer is known as pancreatic adenocarcinoma due to the cells glandular-like (“adeno”) appearance under the microscope, often pancreatic adenocarcinoma is used interchangeably with pancreatic carcinoma.

These tumors typically form in the head or neck of the pancreas, but in some cases tumors form in the tail.

Around 5% of exocrine pancreatic carcinomas are caused by malignancies in the acinar cells, which are the cells that produce the digestive enzymes like trypsinogen, and around 1% are cystadenocarcinomas, or malignant cysts.

There are also other types of pancreatic cancer, but those are even more rare.

Generally, pancreatic carcinoma is caused by genetic mutations in the ductal epithelial cells, and these mutations might activate oncogenes which promote cancer or inactivate tumor suppressor genes.

Either way, this can lead to uncontrolled cell growth caused by the disruptions of the cell signalling pathways that regulate cell survival and growth, as well as multiple immune system responses like inflammation and stress responses.

Although it’s not exactly clear how the genetic mutations that trigger pancreatic carcinoma develop, there are some well known modifiable risk factors like smoking which increases the risk by two to five-fold, obesity, as well as eating a diet high in red meat.

There are also some non-modifiable risk factors like being male, being African American, and being over 65 years old.

Also, certain other diseases seem to increase the risk of developing pancreatic carcinoma as well, like diabetes, chronic pancreatitis, and liver cirrhosis, all of which are linked to excessive alcohol consumption, so there does seem to be an indirect relationship between pancreatic carcinoma and alcohol as well.

Summary

Pancreatic cancer is an aggressive tumor arising from the pancreatic duct mostly of the head or neck. The most common type of pancreatic cancer is pancreatic adenocarcinoma. Symptoms of pancreatic cancer can include abdominal pain radiating to the back, weight loss, jaundice, loss of appetite, nausea, and fatigue.

Pancreatic cancer is caused by genetic mutations in the ductal epithelial cells, which activate oncogenes that promote cancer or inactivate tumor suppressor genes. The risk factors include smoking, a family history of pancreatic cancer, and certain medical conditions such as diabetes and pancreatitis. Treatment for pancreatic cancer may include surgery, chemotherapy, or radiotherapy, depending on the stage of cancer and the patient's overall health.

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