Updated by Anna Torgeson

1. Appx how many pancreatic adenocarcinoma (PCA) pts are diagnosed per yr in the United States?  

2. Where does PCA rank in cancer incidence in the United States? Cancer mortality?  

3. Is there a racial or sex predilection for PCA?  

4. In what decades of life does PCA incidence peak?  

5. What are 3 environmental exposures associated with PCA?  

6. What % of PCA is familial?  

7. What 2 genetic mutations have most frequently been associated with familial PCA?  

8. Is chronic pancreatitis associated with increased risk of PCA?  

9. Appx at what vertebral bodies are the pancreas, celiac axis, and superior mesenteric artery (SMA) located?  

10. What % of PCA arise in the head, body, and tail of the pancreas?  

11. What is the distribution of local, regional, and metastatic Dz at Dx?  

12. For PCA, what are the 3 most common sites of DM?  

13. Is there a role for screening in PCA?  

14. What % of pancreatic tumors are from the exocrine pancreas?  

15. What are the 4 most common pathologic subtypes of exocrine pancreatic tumors?  

16. What are the most common oncogenes in PCA?  

17. What are the most common presenting signs & Sx of PCA?  

18. What Dz is commonly diagnosed 1-2 yrs prior to a PCA Dx?  

19. Periampullary cancers refer to tumors arising from what 4 structures?  

1. What is the DDx of a pancreatic mass?  

2. What is the initial workup for suspected PCA?  

3. In what circumstance will a PCA pt not excrete any CA 19-9?  

4. What is the appropriate imaging for suspected PCA?  

5. Name 4 appropriate procedures for obtaining tissue from a suspicious pancreatic mass.  

6. When is it appropriate to obtain tissue prior to Sg for lesions suspicious on imaging?  

7. What is the major advantage of EUS-guided FNA over CT-guided FNA of a pancreatic mass?  

8. When is ERCP indicated instead of EUS?  

9. What is the NCCN 2018 classification scheme for PCA?  

10. What 3 criteria are necessary for a primary pancreatic tumor to be resectable (per NCCN)?  

11. What characteristics make a primary pancreatic tumor unresectable (per NCCN)?  

12. What are the characteristics of borderline resectable pancreatic head/body tumors (per NCCN)?  

13. What pancreatic tail lesions are considered “borderline resectable”?  

14. What location of PCA is associated with higher rates of resectability: head, body, or tail?  

15. At presentation, what % of PCA pts are resectable?  

16. What % of pts with resectable PCA tumors by CT imaging will be resectable at the time of Sg?  

17. What is the role of staging laparoscopy?  

18. What imaging is indicated to assess for metastatic Dz?  

19. What is the significance of a postresection CA 19-9>90 U/mL?  

20. What is the AJCC 8^th edition (2017) T and N staging for PCA?  

21. What are the AJCC 8^th edition (2017) stage groupings for PCA?  

22. What is the stage of a PCA pt with positive cytology at time of laparoscopy?  

23. Does the AJCC 8^th edition (2017) TNM staging for ampullary, bile duct, and duodenal cancer differ from PCA?  

1. What is the 5-yr OS for all stages of PCA?  

2. What surgical procedure is required to resect a pancreatic head lesion?  

3. What anastomoses are performed in the classic pancreaticoduodenectomy (Whipple)?  

4. What are the 4 most favorable prognostic factors after resection?  

5. What is the modern MS for unresectable, margin-resected, and margin+ resected PCA pts?  

6. What is the current mortality rate for pancreaticoduodenectomy?  

7. What is the most feared complication for pancreaticoduodenectomy?  

8. Is there a benefit to R1 or R2 resection over definitive CRT for PCA?  

9. Should pts with resectable PCA undergo extended retroperitoneal lymphadenectomy?  

10. Can definitive CRT replace surgical resection for resectable PCA?  

11. What are the adj Tx options for a PCA pt s/p resection?  

12. What is the standard postop RT Tx volume, dose, and fractionation for PCA?  

13. For pts with resected PCA, LF is the site of 1^st failure for what % of pts treated with adj CRT? Distant failure as the 1^st site?  

14. What U.S. study 1^st reported a benefit of adj CRT vs. no additional Tx for resected PCA? Describe the arms of this study and the major results.  

15. Did the EORTC 40891 study on PCA support or contest the benefit of adj CRT?  

16. Did the ESPAC-1 study on PCA support or contest the benefit of adj CRT?  

17. How does the presence of a+margin after resection for PCA influence the decision for adj CRT?  

18. Which study supports the role for adj gemcitabine for resected PCA over best supportive care? What subset of pts were excluded from this trial?  

19. What study compared adj 5-FU to gemcitabine following surgical resection?  

20. Did the study RTOG 9704 on PCA support or contest a benefit of gemcitabine-based adj CRT?  

21. What is the Tx paradigm for borderline resectable PCA?  

22. What neoadj regimen should be used for borderline resectable PCA?  

23. What is the Tx paradigm for locally advanced PCA?  

24. What is the role of regional LN RT with neoadj or definitive CRT for borderline resectable or locally advanced PCA?  

25. What is the evidence to support induction chemo prior to CRT in locally advanced PCA?  

26. What definitive CRT regimen should be used for locally advanced PCA?  

27. What study established the role of definitive CRT vs. RT alone in locally advanced PCA? What were the study arms and survival outcomes?  

28. What study suggests that gemcitabine alone may be sup to 5-FU-based CRT in locally advanced PCA? What were the study arms and survival outcomes?  

29. What study suggests that concurrent gemcitabine-based CRT is sup to gemcitabine alone for locally advanced PCA?  

30. What were the trial design, findings, and criticisms of the recent trial, LAP-07, regarding Tx for locally advanced PCA?  

31. What 2 regimens may have greater activity than gemcitabine alone in metastatic PCA?  

32. Estimate the MS and 1-yr OS for pts with locally advanced PCA at Dx, based on LAP-07.  

33. In PCA pts, what are 3 Tx options for tumor-associated biliary obstruction?  

34. In PCA pts, what are 3 Tx options for tumor-associated gastric outlet obstruction?  

35. In PCA pts, what Tx should be considered for tumor-associated severe abdominal pain refractory to analgesic med?  

36. Are there any data on stereotactic body radiotherapy (SBRT) for pancreatic cancer?  

37. Is there a potential for dose escalation with the use of IMRT in pancreatic cancer?  

38. Do Tx paradigms differ b/t pancreatic and periampullary adenocarcinoma?  

1. What are the expected acute and late RT toxicities associated with Tx of resected and unresectable PCA?  

2. What are duodenal toxicities related to fractionated RT or SBRT for PCA?  

3. What is the typical f/u schedule after Tx of pancreatic cancer?