Pancreatic cancer
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Pancreatic cancer
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USMLE® Step 1 style questions USMLE
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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 |
Which of the following additional findings will be most likely present on this patient’s physical examination?
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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.