Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 1146 - файл
.pdf
13 Pancreatic Cancer
https://t.me/med1917
183
11. A patient has been diagnosed with exocrine pancreatic cancer, and genetic
assessment is essential. Which statement about the molecular pathogenesis of
exocrine pancreatic cancer is incorrect?
A. All patients diagnosed with pancreatic cancer should undergo assessment of
their risk of a familial predisposition to cancer with a detailed personal and
family cancer history.
B. BRCA1, as well as BRCA2 mutations, have the potential for an increased
risk of pancreatic cancer.
C. Up to 20% of patients with pancreatic cancer have germline mutations in
known cancer predisposition syndromes.
D. Both FAP and HNPCC have an increased risk of developing pancre-
atic cancer.
E. Testing and gene proling of tumor tissue (i.e., with next-generation
sequencing) should be undertaken as quickly as possible after diagnosis.
Answer: B
Explanation: BRCA2 mutations, but not BRCA1 mutations, have the
potential for an increased risk of pancreatic cancer.
12. A patient is diagnosed with serous cystadenoma in the pancreas. Understanding
its characteristics is crucial. Which statement about serous cystadenoma is
incorrect?
A. It is the most common benign pancreatic tumor.
B. It arises from the pancreatic exocrine portion.
C. It can be reliably cured with surgical removal alone.
D. Based on imaging alone, the benign nature can be conrmed with certainty.
E. It has a premalignant potential.
Answer: E
Explanation: Serous adenomas are benign lesions in the pancreas and do
not have a malignant potential.
13. A patient is diagnosed with a pancreatic tumor, and understanding its pathology
is essential. Which statement about pancreatic tumors’ pathology is incorrect?
A. Exocrine pancreatic tumors are the majority.
B. Ductal adenocarcinoma comprises 85% of all pancreatic exocrine tumors.
C. Neuroendocrine tumors (NETs) account for less than 5% of pancre-
atic tumors.
D. Colloid carcinoma is a subtype of endocrine pancreatic tumors.
E. Adenosquamous carcinoma has the poorest prognosis among pancreatic
ductal adenocarcinoma subtypes.
Answer: D
Explanation: Colloid carcinoma is a subtype of exocrine pancre-
atic tumors.
184
https://t.me/med1917
R. R. Altur et al.
14. A 60-year-old patient is being evaluated for suspected pancreatic cancer. Proper
staging workup is essential to determine resectability. Which statement regarding the staging workup of pancreatic cancer is incorrect?
A. CT abdomen and pelvis with IV contrast and triphasic study is the gold
standard modality for proper preoperative locoregional staging and assess-
ment of resectability.
B. Routine staging chest CT for patients suspected of having pancreatic cancer
who have no symptoms to suggest pulmonary metastases is not
recommended.
C. Routine use of PET/CT for staging of pancreatic cancer is advisable.
D. EUS-guided ne needle aspiration biopsy (FNAB) is the best modality for
obtaining a tissue diagnosis.
E. Up to one-third of patients thought to be resectable by state-of-the-art imag-
ing will be found to be unresectable based upon laparoscopic ndings.
Answer: C
Explanation: Routine use of PET/CT for staging of pancreatic cancer is
not recommended.
15. A 70-year-old patient presents with symptoms suggestive of pancreatic cancer.
Understanding the differential diagnosis is essential for accurate diagnosis.
Which statement about the differential diagnosis of pancreatic cancer is
incorrect?
A. There is a large list of differentials for pancreatic cancer because the symp-
toms are nonspecic.
B. A solid pancreatic lesion is uncommonly found as an incidental nding on
CT scans done for another reason.
C. The positive predictive value (PPV) of jaundice, abdominal pain, and
abdominal mass for the diagnosis of pancreatic cancer is low, with the pos-
sible exception of jaundice in an older patient.
D. The most common primary sites for pancreatic metastases are renal cell
carcinoma and melanoma.
E. Differentiating a primary exocrine pancreatic carcinoma from other less
common periampullary malignancies is straightforward.
Answer: E
Explanation: Differentiating a primary exocrine pancreatic carcinoma
from other less common periampullary malignancies can be challenging.
16. A 58-year-old patient presents with symptoms suggestive of pancreatic cancer.
Diagnostic imaging is crucial for further evaluation. Which statement about
pancreatic cancer imaging modalities is incorrect?
A. For patients with jaundice, the initial imaging study is often transabdominal
ultrasound (US).
13 Pancreatic Cancer
https://t.me/med1917
185
B. If a pancreatic mass is seen on transabdominal US, an abdominal CT scan
is typically next obtained to conrm the presence of the mass and to assess
disease extent.
C. If a pancreatic cancer is suspected, a “pancreatic protocol” (i.e., multiphase
contrast-enhanced, helical) CT of the abdomen and pelvis is warranted.
D. Oral contrast is mandatory for proper preoperative assessment of
respectability.
E. MRI has similar sensitivity and specicity to CT scan regarding the identi-
cation of the mass and metastatic spread.
Answer: D
Explanation: CT abdomen and pelvis with IV contrast and triphasic
study is the protocol of choice for locoregional staging of pancreatic cancers. There is no need for oral contrast in preoperative settings.
17. A 63-year-old patient is being evaluated for suspected pancreatic cancer. A precise diagnostic approach is crucial for accurate diagnosis and management.
Which statement regarding the diagnostic approach for pancreatic cancer is
incorrect?
A. CA 19-9 level sensitivity is not affected by tumor size.
B. A typical nding on imaging is satisfactory before proceeding to surgery if
resectability is eligible.
C. Pancreatic biopsy is usually done by FNA/cytology if histological conr-
mation is needed in atypical cases of irresectable tumors.
D. Endoscopic US can be used for locoregional staging as an alternative to
CT scan.
E. ERCP is indicated if biliary decompression is needed.
Answer: A
Explanation: CA 19-9 level sensitivity is limited for small lesions.
18. A 56-year-old patient with a pancreatic mass requires histological conrmation. Choosing the appropriate biopsy method is essential. Which statement
about pancreatic mass FNA/tru-cut biopsy is incorrect?
A. Percutaneous FNA biopsy of the pancreas may disseminate tumor cells
intraperitoneally or along the needle path.
B. FNA/tru-cut biopsy of pancreatic masses is dependent on tumor size and
operator expertise, with sensitivity reaching more than 85%.
C. FNA/biopsy is indicated in cases when histological conrmation is needed
but resectability is not amenable.
D. EUS-guided FNA is the preferred modality for obtaining a tissue
diagnosis.
E. If FNA specimens are inadequate or nondiagnostic, EUS-guided ne needle
(core) biopsy may be considered.
Answer: A
186
https://t.me/med1917
R. R. Altur et al.
Explanation: The risk that percutaneous FNA biopsy of the pancreas
may disseminate tumor cells intraperitoneally or along the needle path is
only theoretical and quite low or absent.
19. A 60-year-old patient is undergoing evaluation for pancreatic cancer. The
medical team is assessing the extent of the disease to determine whether it is
advanced and incurable. Which of the following statements regarding signs of
advanced and incurable pancreatic cancer is incorrect?
A. Liver metastases are a sign of advanced pancreatic cancer.
B. Ascites is indicative of advanced disease.
C. Presence of an abdominal mass suggests advanced pancreatic cancer.
D. Supraclavicular lymph nodes involvement indicates advanced disease.
E. Jaundice is a sign of advanced and incurable pancreatic cancer.
Answer: E
Explanation: Jaundice is a relatively early sign of pancreatic tumors,
often caused by the obstruction of the bile duct by the tumor. It does not
necessarily indicate advanced or incurable disease, unlike the other
signs listed.
20. A 64-year-old patient with pancreatic cancer is evaluated for resectability.
Which of the following features is incorrect indicative of irresectable disease?
A. Encasement of SMA by more than 180°.
B. Inseparability from adjacent organs (e.g., spleen).
C. Short segment of vascular venous involvement.
D. Metastases to lymph nodes beyond the peripancreatic region.
E. SMA thrombosis.
Answer: C
Explanation: If venous occlusion is present, a suitable segment of portal
vein (above) and SMV (below the site of venous involvement) must be
present to allow for venous reconstruction. However, in most centers, surgery will be preceded by some form of neoadjuvant treatment for patients
with venous occlusion.
21. A 59-year-old patient presents with obstructive jaundice, and ampullary carcinoma is suspected. Select the incorrect statement regarding the diagnostic
workup for ampullary carcinoma.
A. A transabdominal ultrasound is a reasonable rst test in patients presenting
with obstructive jaundice.
B. ERCP is the preferred modality for diagnosis.
C. It may be difcult to completely exclude carcinoma on endoscopic nd-
ings alone.
D. Contrast-enhanced CT scan is the most accurate modality available to
assess the T stage of ampullary tumors.
13 Pancreatic Cancer
https://t.me/med1917
187
E. MRCP is indicated if the patient cannot tolerate invasive procedures or
there is obstruction that limits cannulation of pancreaticobiliary channels.
Answer: D
Explanation: EUS is the most accurate modality available to assess the T
stage of ampullary tumors, although it is not done routinely.
22. A 58-year-old patient is diagnosed with pancreatic adenocarcinoma, and the
management plan is being discussed. Choose the incorrect statement regarding
the management of pancreatic cancer.
A. Surgical resection is the only potentially curative treatment for pancreatic
adenocarcinoma.
B. Forty percent of patients are candidates for pancreatectomy.
C. Patients with borderline resectable or locally advanced unresectable pancre-
atic cancer, but no metastatic disease, are potential candidates for downstag-
ing with neoadjuvant therapy.
D. Neoadjuvant therapy is increasingly considered an acceptable option for
patients with potentially resectable pancreatic cancer.
E. Encasement (more than one-half of the vessel circumference) is an absolute
contraindication for surgery.
Answer: B
Explanation: Unfortunately, because of the late presentation, only 15 to
20 percent of patients are candidates for pancreatectomy. Although uncommon, some patients with initially unresectable or borderline resectable disease may be downstaged to resectable disease with neoadjuvant treatment.
23. A 65-year-old patient is scheduled for a Whipple procedure due to pancreatic
cancer. Which statement regarding the conventional Whipple procedure is
incorrect?
A. Removal of the entire pancreas.
B. Removal of the gallbladder and common bile duct.
C. Partial gastrectomy.
D. Duodenectomy.
E. Removal of the rst 15cm of the jejunum.
Answer: A
Explanation: Conventional Whipple procedure includes the removal of
the head of the pancreas and not the entire pancreas.
24. A 62-year-old patient with pancreatic cancer is discussing treatment options.
Identify the incorrect statement about pancreaticoduodenectomy (Whipple
procedure).
A. It is the only curative treatment for pancreatic cancer cases.
B. Extended lymphadenectomy, when performed, is superior to conventional
lymphadenectomy.
188
https://t.me/med1917
R. R. Altur et al.
C. Pylorus-preserving pancreaticoduodenectomy has the same results as
pylorectomy.
D. Vascular resection and reconstruction at the time of pancreaticoduodenec-
tomy is controversial.
E. Minimally invasive (laparoscopic, robotic-assisted) pancreaticoduodenec-
tomy is technically feasible.
Answer: B
Explanation: The evidence to support a benet from extended lymphadenectomy is conicting, with some trials suggesting benet limited to the
setting of positive nodes, others suggesting no survival benet in any subgroup, and two suggesting worse quality of life following extended
lymphadenectomy.
25. A 58-year-old man with a history of type 2 diabetes and chronic pancreatitis
presents with jaundice, weight loss, and abdominal pain radiating to the back.
Imaging studies suggest a mass at the head of the pancreas, and further evaluation including biopsy conrms adenocarcinoma. The patient undergoes a pancreaticoduodenectomy (Whipple procedure). Postoperatively, the surgical team
discusses the prognosis and future management with the patient and his family.
Which of the following statements regarding the outcomes of Whipple procedure is incorrect?
A. The prognosis of cases remains poor even with negative surgical margins.
B. Newer multiagent adjuvant chemotherapy regimens signicantly increase
both median and 5-year survival after surgical resection.
C. Perioperative mortality of pancreaticoduodenectomy in most modern series
is less than 3%.
D. There is a signicant association between hospital volume and postopera-
tive mortality.
E. There is improvement over time regarding outcomes of this procedure.
Answer: C
Explanation: In most modern series, the perioperative mortality of pancreaticoduodenectomy (Whipple procedure) is less than 3%, not 25%. This
procedure has seen improvements in outcomes over time, and there is
indeed a signicant association between hospital volume and postoperative
mortality in pancreaticoduodenectomy cases. However, it’s important to
note that even with negative surgical margins, the prognosis for patients
undergoing this procedure can still be poor due to the aggressive nature of
pancreatic cancer. The use of newer multiagent adjuvant chemotherapy
regimens has also shown promise in increasing survival rates after surgical
resection.
26. A 64-year-old patient presents with a tumor located in the body of the pancreas.
Which statement regarding pancreatic body/tail tumors is incorrect?
A. The majority have locally advanced or metastatic disease at the time of
presentation.
13 Pancreatic Cancer
https://t.me/med1917
189
B. Usually, they do not cause obstruction of the intrapancreatic portion of the
common bile duct.
C. They have a worse prognosis compared to those with cancers involving the
head of the pancreas.
D. Surgical resection consists of total pancreatectomy, usually combined with
splenectomy.
E. Most commonly include ductal adenocarcinoma.
Answer: D
Explanation: Surgical resection of cancers located in the body or tail of
the pancreas consists of a distal subtotal pancreatectomy, usually combined
with splenectomy.
27. A 60-year-old patient is scheduled for pancreatic cancer resection surgery.
Which statement regarding perioperative care is incorrect?
A. Biliary decompression/drainage is advised if bilirubin >250μmol/L.
B. Oral bowel preparation is recommended.
C. Nasogastric tube does not improve outcomes and is not recommended
routinely.
D. Early removal of the drain after 72h in patients with a low risk of develop-
ing pancreatic stula.
E. Removal of the urinary catheter is advised on the rst postoperative day,
along with early mobilization.
Answer: B
Explanation: Oral bowel preparations are not needed for pancreatic can-
cer resection procedures.
28. A 68-year-old man with a recent diagnosis of pancreatic cancer is being evaluated
for treatment options. The tumor is located in the head of the pancreas and appears
to be borderline resectable on imaging. The patient has a good performance status
with manageable comorbidities. In the context of treatment decision- making for
pancreatic cancer, which of the following statements is incorrect?
A. The decision to pursue surgery for pancreatic cancer should be based on a
comprehensive assessment, including but not limited to the stage of the
disease.
B. The patient’s performance status and comorbidities are critical factors in
determining eligibility for surgical intervention.
C. Neoadjuvant chemotherapy is the preferred approach for managing border-
line resectable pancreatic tumors to potentially increase the chances of a
successful resection.
D. For patients with locally advanced unresectable pancreatic cancer, palliative
chemotherapy can be offered to manage symptoms and potentially improve
survival.
E. Engaging in multidisciplinary tumor board discussions is crucial for formu-
lating a comprehensive and individualized treatment plan for pancreatic
cancer patients.
190
https://t.me/med1917
R. R. Altur et al.
Answer: A
Explanation: The decision to pursue surgery for pancreatic cancer should
not be based solely on the stage of the disease. It is essential to consider a
variety of factors, including the patient’s performance status, comorbidities,
and the tumor’s resectability. Neoadjuvant chemotherapy is often recommended for borderline resectable tumors to potentially increase the chances
of successful surgery. For locally advanced unresectable disease, palliative
chemotherapy is an option to improve quality of life and survival.
Multidisciplinary tumor board discussions are essential in planning the
treatment approach for pancreatic cancer patients.
29. A 52-year-old woman with a strong family history of pancreatic cancer is being
evaluated for her risk of developing the disease. Her mother and maternal uncle
were diagnosed with pancreatic cancer in their 60s. She is considering genetic
counseling and testing. In the context of pancreatic cancer and genetic risk factors, which of the following statements is incorrect?
A. Individuals with a family history of pancreatic cancer have no increased risk
of developing the disease compared to the general population.
B. Mutations in BRCA1 and BRCA2 genes are associated with an elevated
risk of pancreatic cancer.
C. Hereditary pancreatitis, a genetic condition, signicantly increases the risk
of developing pancreatic cancer over time.
D. Patients with Lynch syndrome (hereditary nonpolyposis colorectal cancer,
HNPCC) are at an increased risk of pancreatic cancer.
E. Genetic counseling and testing are recommended for individuals with a
strong family history of pancreatic cancer to assess their risk and guide
screening strategies.
Answer: A
Explanation: Individuals with a family history of pancreatic cancer do
have an increased risk of developing the disease. Genetic factors such as
mutations in BRCA1, BRCA2, and genes associated with hereditary pancreatitis and Lynch syndrome can signicantly elevate the risk of pancreatic
cancer. Therefore, genetic counseling and testing are important for
individuals with a strong family history of the disease to identify potential
genetic risks and inform appropriate screening and preventive measures.
30. A 64-year-old man undergoes a pancreaticoduodenectomy (Whipple procedure) for pancreatic adenocarcinoma. Postoperatively, he is closely monitored
for potential complications associated with the surgery. In the context of pancreatic cancer treatment-related complications, which of the following statements is incorrect?
A. Whipple procedure is associated with a low risk of postoperative pancreatic
stula.
13 Pancreatic Cancer
https://t.me/med1917
191
B. Delayed gastric emptying is a frequent complication following pancreatic
surgery and can impact patient recovery and nutrition.
C. Pancreatic exocrine insufciency is a common consequence of pancreatic
resection, often necessitating enzyme replacement therapy to aid digestion.
D. Anastomotic leakage at the surgical site is a serious complication of pancre-
atic surgery that can lead to signicant morbidity.
E. Biliary stricture can occur as a complication after pancreaticoduodenec-
tomy, necessitating endoscopic or surgical intervention for management.
Answer: A
Explanation: Pancreaticoduodenectomy (Whipple procedure) is a complex surgical procedure associated with a signicant risk of postoperative
complications. One of the most common complications is the development
of a postoperative pancreatic stula, which occurs when there is a leak of
pancreatic uid from the surgical site. This is a well-recognized risk and is
not considered a low-risk complication. Delayed gastric emptying, pancreatic exocrine insufciency, anastomotic leakage, and biliary stricture are
other potential complications that can occur following pancreatic surgery
and require careful management to optimize patient outcomes.
31. A 70-year-old woman with metastatic pancreatic cancer is experiencing signicant pain and a decrease in quality of life. The oncology team is discussing the
integration of palliative care into her treatment plan. In the context of palliative
care in pancreatic cancer, which of the following statements is incorrect?
A. Palliative care should be initiated only in the terminal stages of pancreatic
cancer when other treatments are no longer effective.
B. Palliative care encompasses a holistic approach, including symptom man-
agement, psychological support, and end-of-life care.
C. Integrating palliative care alongside active cancer treatment from the time
of diagnosis can improve the patient’s quality of life and overall well-being.
D. Effective symptom control and pain management are central components of
palliative care, aiming to alleviate the patient’s suffering.
E. The palliative care team is multidisciplinary, consisting of healthcare pro-
fessionals such as palliative care physicians, nurses, social workers, and
chaplains.
Answer: A
Explanation: Palliative care is not limited to the terminal stages of pancreatic cancer but can be integrated alongside active cancer treatment from
the time of diagnosis. It aims to improve the quality of life for patients by
addressing physical symptoms, emotional and spiritual needs, and providing support for both patients and their families. The multidisciplinary palliative care team works collaboratively to provide comprehensive care
throughout the course of the illness.
192
https://t.me/med1917
R. R. Altur et al.
32. A 72-year-old man with locally advanced pancreatic cancer is experiencing
obstructive jaundice and gastric outlet obstruction. The surgical oncology team
is considering palliative surgical options to alleviate his symptoms. In the context of palliative surgery in pancreatic cancer, which of the following statements is incorrect?
A. Palliative surgery is often performed with the primary goal of achieving
curative intent in patients with locally advanced pancreatic cancer.
B. Various techniques can be utilized for palliative bypass surgery to alleviate
obstructive jaundice, including biliary bypass or endoscopic stent placement.
C. The primary aim of palliative surgery in pancreatic cancer is to relieve
symptoms and enhance the patient’s quality of life.
D. Surgical gastrojejunostomy is a palliative option for relieving gastric outlet
obstruction in patients with pancreatic cancer.
E. In cases of unresectable pancreatic cancer, palliative surgical procedures
such as cholecystostomy or hepaticojejunostomy may be considered to
manage symptoms.
Answer: A
Explanation: Palliative surgery in pancreatic cancer is not typically performed with curative intent, especially in patients with locally advanced
disease. Instead, the primary goal of palliative surgery is to alleviate symptoms such as obstructive jaundice or gastric outlet obstruction and improve
the patient’s quality of life. Techniques like biliary bypass or stent placement, gastrojejunostomy, cholecystostomy, and hepaticojejunostomy are
aimed at symptom relief rather than curing the disease.
33. A 66-year-old woman with borderline resectable pancreatic cancer has completed neoadjuvant chemotherapy. The multidisciplinary team is discussing the
potential role of CRT in her treatment plan. In the context of CRT in pancreatic
cancer, which of the following statements is incorrect?
A. CRT is routinely used as the initial treatment modality for all stages of pan-
creatic cancer.
B. CRT may be considered for patients with borderline resectable disease after
completion of neoadjuvant therapy to enhance the chances of successful
resection.
C. For locally advanced unresectable pancreatic cancer, CRT can be utilized to
control disease progression and alleviate symptoms.
D. Intensity-modulated radiation therapy is a technique that allows for more
precise delivery of radiation to the tumor, minimizing exposure to surrounding healthy tissue.
E. In certain cases, CRT may be combined with systemic chemotherapy to
improve treatment efcacy and patient outcomes.
Соседние файлы в папке @xirurgi_2025