Chapter 14 Answers to self-check questions

Cytology of the biliary tract and pancreas

14.1 What could be the possible explanation for reduction in cytology samples types from the gastrointestinal tract?

Widespread use of flexible fiberoptic endoscopy has allowed for  high resolution  visualization of the  GI tract. The endoscopist can take high quality biopsy samples which are in many ways superior to the brush cytology samples.

 

14.2 What is the function of bile?

The main function of bile is digestion of fats. Bile also provides a route of excretion for bilirubin, a by product of red blood cells, broken down by the liver.

 

14.3 What are the islets of Langerhans?

The isledt of Langerhans are the areas in the pancreas which include the endocrine cells which produce the various hormone incudfing insulin, glucagon and somatostatin

 

14.4 What is the main advantage of EUS-FNA, compared to percutaneous CT guided FNA of the pancreas?

Better visualisation of the of the needle tip in real-time and the close proximity of the ultrasound probe to the pancreas produces very clear images. This better imaging allows for more accurate sampling of small lesions (<1 centimeter) that could not be seen under CT guidance.

 

14.5 What are the main risk factors for development of cholangiocarcinoma?

Old age, the majority of patient’s are  in their 60s, inflammatory conditions such as primary sclerosing cholangitis (PSC)  and ulcerative colitis  Congential anolomlies  such as choledochal cyst and Caroli’s disease. In Asia a parasitic liver fluke is a known risk factor. A radiologic contrast dye, Thorotrast (thorium dioxide) that was used in the in the 1950s. Other risk factors which are not fully proven include diabetes, being overweight, excess alcohol consumption and smoking.

 

14.6 What are the main presenting symptoms of cholangiocarcinoma?

Jaundice with its associated symptoms.  Other symptoms include loss of appetite, weight loss, feeling tired and pain in the abdomen. These symptoms are not specific for cholanagicarcinoma and may be due to other conditions.

 

14.7 What is the main challenge to selecting patients for targeted therapies?

The great diversity of different mutations poses a challenge for assessing the patients for effective targeted therapies.

 

14.8 What is the reason for the poor prognosis of pancreatic cancer?

Pancreatic cancer is seldom detected in its early stages, which is a major reason why it is  leading cause of cancer death. Signs and symptoms do not appear until it is quite advanced. Complete surgical removal is not often possible.