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Abramson Cancer CenterNCI CANCERLIT® Search: Diagnosis-Histopathology-Pathogenesis of Pancreatic Cancer - October 2001
National Cancer Institute®
Last Modified: November 21, 2001
Table of Contents
1
UI - 20452441
AU - Hirshberg B; Livi A; Bartlett DL; Libutti SK; Alexander HR; Doppman JL;
TI -
Skarulis MC; Gorden P
Forty-eight-hour fast: the diagnostic test for insulinoma.
SO - J Clin Endocrinol Metab 2000 Sep;85(9):3222-6
AD - Division of Intramural Research, National Institute of Diabetes,
Digestive and Kidney Diseases, National Institutes of Health, Bethesda,
Maryland 20892, USA.
Insulinoma causes fasting hypoglycemia due to inappropriate insulin
secretion. Its diagnosis is based on demonstrating Whipple's triad
during a supervised 72-h fast. For 75 yr, the 72-h fast has been the
cornerstone for the diagnosis; however, it has never been critically
assessed using newer assays for insulin, C peptide, and proinsulin.
Thus, the aim of the current study is to assess the need for a full 72-h
fast for the diagnosis of insulinoma. Patients with suspected
hypoglycemia with documented glucose concentrations below 45 mg/dL were
admitted to the NIH. Data obtained during the supervised fast of
patients with pathologically proven insulinoma over a 30-yr period
(1970-2000) were reviewed. We identified 127 patients with insulinoma.
The average age of patients was 42.7 +/- 15.9 yr, with a predominance of
females (62%). 107 patients had a benign tumor, 20 had malignant
insulinoma, and 15 patients had multiple endocrine neoplasia type 1. The
fast was terminated due to hypoglycemia in 44 patients (42.5%) by 12 h,
85 patients (66.9%) by 24 h, and 120 (94.5%) by 48 h. Seven patients
fasted beyond 48 h despite subtle neuroglycopenic symptoms and glucose
and insulin concentrations diagnostic of insulinoma. Immunoreactive
proinsulin was elevated at the beginning of the fast in 90% of 42
patients. Proinsulin in noninsulinoma, in contrast to insulinoma,
patients is usually suppressible; therefore, samples taken in the
suppressed state have the greatest diagnostic value. We conclude that
with the current available insulin and proinsulin assays, the diagnosis
of insulinoma can be made within 48 h. Thus, the 48-h fast should
replace the 72-h fast in textbooks and hospital protocols as the new
diagnostic standard.
2
UI - 21445653
AU - Vogel I; Kalthoff H
TI -
Disseminated tumour cells. Their detection and significance for
prognosis of gastrointestinal and pancreatic carcinomas.
SO - Virchows Arch 2001 Aug;439(2):109-17
AD - Department of General and Thoracic Surgery, University of Kiel, Germany.
ivogel@surgery.uni-kiel.de
Metastatic spread is a major factor in the prognosis of cancer patients.
Early detection and eradication of circulating tumour cells prior to the
development of metastases could help to improve the outcome of patients
after tumour resection. Disseminated tumour cells have been detected in
different compartments of the body using cytological and immunostaining
methods and, more recently, using different molecular biological
techniques. The most frequently studied body compartments are the bone
marrow, peritoneal cavity, blood and lymph nodes, but other body fluids
such as urine, bile, pancreatic juice and sputum have also been
analysed. At all of these sites, tumour cells have been detected.
However, the specificity and sensitivity of the methods and their
prognostic impact are still being debated. This review discusses the
accuracy of the detection methods and the prognostic value of detecting
disseminated tumour cells in the bone marrow, blood and peritoneal
lavage of patients with colorectal, gastric and pancreatic carcinomas.
3
UI - 20581516
AU - Ji BT; Silverman DT; Stewart PA; Blair A; Swanson GM; Baris D; Greenberg
TI -
RS; Hayes RB; Brown LM; Lillemoe KD; Schoenberg JB; Pottern LM; Schwartz
AG; Hoover RN
Occupational exposure to pesticides and pancreatic cancer.
SO - Am J Ind Med 2001 Jan;39(1):92-9
AD - Division of Cancer Epidemiology and Genetics, National Cancer Institute,
National Institutes of Health, Bethesda, MD 20892, USA.
jib@exchange.nih.gov
BACKGROUND: An increased risk of exposure to pesticides for pancreatic
cancer has been suggested in a number of epidemiologic studies. METHODS:
Cases (N = 484), aged 30-79 years, were diagnosed in 1986-1989. Controls
(N = 2,095) were a random sample of the general population. Information
on usual occupation and potential confounding factors was obtained. A
job-exposure matrix (JEM) approach was used to estimate the level of
occupational exposure to pesticides. RESULTS: A significant trend in
risk with increasing exposure level of pesticides was observed, with ORs
of 1.3 and 1.4 for low and moderate/high exposure levels, respectively.
Excess risks were found for occupational exposure to fungicides (OR =
1.5) and herbicides (OR = 1.6) in the moderate/high level after
adjustment for potential confounding factors. An increased risk for
insecticide exposure was disappeared after adjustment for fungicide and
herbicide exposures. Results of our occupation-based analysis were
consistent with those from the JEM-based analysis. CONCLUSIONS: Our
results suggest that pesticides may increase risk of pancreatic cancer,
and indicate the need for investigations that can evaluate risk by
specific chemical exposures. Published 2001 Wiley-Liss, Inc.
4
UI - 21190933
AU - Tersmette AC; Petersen GM; Offerhaus GJ; Falatko FC; Brune KA; Goggins
TI -
M; Rozenblum E; Wilentz RE; Yeo CJ; Cameron JL; Kern SE; Hruban RH
Increased risk of incident pancreatic cancer among first-degree
relatives of patients with familial pancreatic cancer.
SO - Clin Cancer Res 2001 Mar;7(3):738-44
AD - Department of Pathology, Academic Medical Center, Amsterdam, The
Netherlands.
It has been estimated that familial aggregation and genetic
susceptibility play a role in as many as 10% of patients with pancreatic
cancer (PC). The quantified prospective risk of PC among first-degree
relatives of PC patients has not been investigated. Families enrolled in
the National Familial Pancreas Tumor Registry (NFPTR) prior to September
1, 1998 were followed to estimate the risk and incidence of PC among
first-degree relatives of patients with PC. Analyses were performed
separately on kindreds with at least two first-degree relatives with PC
(familial pancreatic carcinoma (PC); n = 150) at the time the kindred
was enrolled in the NFPTR and on kindreds without a pair of affected
first-degree relatives (sporadic PC; n = 191). A subanalysis was
performed on familial PC kindreds containing three or more affected
members at the time of enrollment in the NFPTR (n = 52). Risk was
estimated by comparing observed new cases of PC during the observation
period with expected numbers based on the United States population-based
Surveillance, Epidemiology and End Results program data. Incidence was
estimated using person-years risk analyses. During the observational
period, six incident PCs developed in the first-degree relatives: two in
the sporadic PC kindreds, and four in the familial PC kindreds. The PC
risk in the sporadic PC kindreds was not significantly greater than
expected [observed/expected = 6.5 (95% CI = 0.78-23.3)] with an
incidence rate of 24.5/10(5)/ year. There was a significantly increased
18-fold risk (95% CI = 4.74-44.5) of PC among first-degree relatives in
familial PC kindreds, with an incidence of 76.0/10(5)/year. In the
subset of familial PC kindreds with three or more affected family
members at the time of enrollment, there was a 57-fold (95% CI =
12.4-175) increased risk of PC and an incidence of 301.4/10(5)/year
compared with the Surveillance, Epidemiology and End Result age-adjusted
incidence of PC in the U.S. (8.8/10(5)/year). When stratified by age,
the risk was largely confined to relatives over the age of 60. This
study is the first analysis of incident PC occurring in familial PC
kindreds. The risk and incidence of PC is exceptionally high among
at-risk first-degree relatives in familial PC kindreds in which at least
three first-degree relatives have already been diagnosed with PC.
Familial PC kindreds are a reasonable high-risk group for PC screening
and chemoprevention research.
5
UI - 21454835
AU - Fink C; Grenacher L; Hansmann HJ; Dux M; Leipold R; Spielhaupter E;
TI -
Kauffmann GW; Richter GM
[Prospective study to compare high-resolution computed tomography and
magnetic resonance imaging in the detection of pancreatic neoplasms: use
of intravenous and oral MR contrast media]
SO - Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2001
Aug;173(8):724-30
AD - Abteilung Radiodiagnostik Radiologische Universitatsklinik Heidelberg.
PURPOSE: To compare thin-section hydro-CT and MRI in the detection of
pancreatic neoplasms. Evaluation of an oral, superparamagnetic contrast
agent (OMP) for pancreatic MRI. MATERIAL AND METHODS: 45 patients with
suspected pancreatic neoplasms were examined with consecutive
thin-section helical CT (Hydro-CT, 3/6/3, 130 ml Ultravist, Schering)
and MRI (1.0 T, breath-holding, T1w-GRE, T1w-GRE fat-sat, T2w-TSE). The
MRI protocol included precontrast studies, studies after oral
administration of OMP (Abdoscan, Nycomed Amersham) and studies after
administration of OMP and Gadodiamide i.v. (Omniscan, Nycomed Amersham).
All images were assessed by two independent radiologists in a blinded
fashion. Radiologic diagnosis was correlated with histology or clinical
follow-up (> or = 3 month). RESULTS: 39 patients could be included in
analysis. In 13 cases a pancreatic neoplasm was proven by histology.
Thin-section hydro-CT and MRI showed no statistically significant
differences for the detection of pancreatic neoplasia. The sensitivity
of helical hydro-CT was superior compared to MRI (88.5% vs.
65.44/73.1%/76.9%). The specificity of MRI was superior compared to
helical hydro-CT (86.5% vs. 94.2%/90.4%/88.5%). CONCLUSION: Thin-section
hydro-CT and MRI show similar results for the detection of pancreatic
neoplasms. Compared to thin-section helical CT, MRI still has the
drawbacks of much more time consumption and, still, lower spatial
resolution. The use of an oral, superparamagnetic contrast agent added
no advantage for pancreatic MRI.
6
UI - 21450510
AU - Chatziioannou A; Kehagias D; Mourikis D; Antoniou A; Limouris G; Kaponis
TI -
A; Kavatzas N; Tseleni S; Vlachos L
Imaging and localization of pancreatic insulinomas.
SO - Clin Imaging 2001 Jul-Aug;25(4):275-83
AD - Department of Radiology, Areteion Hospital, University of Athens, 76
Vas. Sofias Street, Athens 11528, Greece.
For pancreatic insulinomas, the treatment of choice is surgical
excision, which when successful is curative. Intraoperative palpation
combined with ultrasonography theoretically depict almost all tumors,
however the accuracy of palpation is improved by the preoperative
localization. All recent advances in imaging have improved the
likelihood for curative surgical resection. Our purpose is to
demonstrate the characteristics of all modalities, which may be used in
the preoperative localization algorithm.
7
UI - 21354723
AU - McCarty MF
TI -
Insulin secretion as a determinant of pancreatic cancer risk.
SO - Med Hypotheses 2001 Aug;57(2):146-50
AD - Pantox Laboratories, 4622 Santa Fe St, San Diego, CA 92109, USA.
New epidemiology confirms that glucose intolerance is a risk factor for
pancreatic cancer, and that this association cannot be accounted for by
an adverse impact of early pancreatic cancer on beta cell function.
Previous reports indicate that risk for pancreatic cancer is increased
in adult-onset diabetics. Since streptozotocin diabetes inhibits
carcinogen-mediated induction of pancreatic cancer in hamsters, the most
reasonable interpretation of these findings is that insulin (or some
other beta cell product) acts as a promoter for pancreatic
carcinogenesis. This view is consistent with a report that human
pancreatic adenocarcinomas express insulin receptors that can stimulate
mitosis; an additional possibility is that high insulin levels
indirectly promote pancreatic carcinogenesis by boosting effective IGF-I
activity via hepatic actions. In international ecologic epidemiology,
pancreatic cancer rates correlate tightly with dietary intake of animal
products; this may reflect the fact that vegan diets are associated with
low diurnal insulin secretion. There is also suggestive evidence that
macrobiotic vegan diets, which are low in glycemic index, may increase
mean survival time in pancreatic cancer. However, other types of diets
associated with decreased postprandial insulin response, such as
high-protein diets or 'Mediterranean' diets high in oleic acid, may also
have the potential for pancreatic cancer prevention. The huge increases
of age-adjusted pancreatic cancer mortality in Japan and among
African-Americans during the last century imply that pancreatic cancer
is substantially preventable; a low-insulin-response diet coupled with
exercise training, weight control, and smoking avoidance, commendable
for a great many other reasons, may slash pancreatic cancer mortality
dramatically. Copyright 2001 Harcourt Publishers Ltd.
8
UI - 21413793
AU - Hahn M; Faigel DO
TI -
Frequency of mediastinal lymph node metastases in patients undergoing
EUS evaluation of pancreaticobiliary masses.
SO - Gastrointest Endosc 2001 Sep;54(3):331-5
AD - Division of Gastroenterology, Portland VA Medical Center and Oregon
Health Sciences University, Portland, Oregon 97201, USA.
BACKGROUND: Mediastinal lymph node metastases have rarely been reported
in patients with pancreatic cancer. Our aim was to determine the
frequency of mediastinal lymph node metastases in patients with
pancreaticobiliary masses by using EUS-guided fine needle aspiration.
METHODS: Sixty-six consecutive patients with pancreatobiliary masses
were evaluated on EUS for the presence of mediastinal lymph node
metastases. All masses were staged by commonly used EUS criteria by
using sector scanning echoendoscopes. Mediastinal lymph nodes with EUS
features that suggested malignancy were aspirated. RESULTS: Of the 66
patients (mean age 65.6 years; 38 men), 4 had biliary masses, 5 had
lesions of the major duodenal papilla, and 57 had pancreatic masses.
Eleven patients (10 pancreatic masses, 1 biliary mass) had enlarged
mediastinal lymph node (12-30 mm) on EUS; in 2 patients these had a
benign appearance and were not aspirated. Nine patients underwent
EUS-guided fine needle aspiration: in 1 the cytology was inconclusive
(patient subsequently had a negative Whipple resection); in 4 the
mediastinal lymph node cytology was benign; the remaining 4 patients had
adenocarcinoma cells in the aspirate from mediastinal lymph node. These
4 pancreatic tumors were staged by EUS as T2N1M1 (1), as T4N0M1 (2, one
later found to also have a lung mass), and T4N1M1 (1). CONCLUSION:
Enlarged mediastinal lymph nodes were found on EUS in 16.6% (95% CI
[7.7%, 25.6%]) of patients with pancreatobiliary masses and in 17.5%
(95% CI [7.6%, 27.4%]) of patients with pancreatic masses. The frequency
of mediastinal lymph node metastases in pancreatobiliary masses was 6.1%
(95% CI [0.34%, 11.9%]) and in pancreatic masses 7.0% (95% CI [0.4%,
13.6%]). Routine EUS evaluation of the mediastinum in patients with
pancreatic masses is warranted.
9
UI - 21415379
AU - Sohn TA; Yeo CJ; Cameron JL; Iacobuzio-Donahue CA; Hruban RH; Lillemoe
TI -
KD
Intraductal papillary mucinous neoplasms of the pancreas: an
increasingly recognized clinicopathologic entity.
SO - Ann Surg 2001 Sep;234(3):313-21; discussion 321-2
AD - Department of Surgery, the Johns Hopkins Medical Institutions,
Baltimore, Maryland 21287-4606, USA.
OBJECTIVE: To assess the authors' experience with intraductal papillary
mucinous neoplasms of the pancreas (IPMNs). SUMMARY BACKGROUND DATA:
Intraductal papillary mucinous neoplasms of the pancreas are being
recognized with increasing frequency. METHODS: All patients who
underwent pancreatic resection for an IPMN at the Johns Hopkins Hospital
compared with those of 702 concurrent patients with infiltrating ductal
adenocarcinoma of the pancreas not associated with an IPMN resected by
pancreaticoduodenectomy. RESULTS: In the 13-year time period, 60
patients underwent pancreatic resection for IPMNs, with 40 patients
undergoing resection in the past 3 years. Mean age at presentation was
67.4 +/- 1.4 years. The most common presenting symptom in patients with
IPMNs was abdominal pain (59%). Most IPMNs were in the head of the
pancreas or diffusely involved the gland, with 70% being resected via
pancreaticoduodenectomy, 22% via total pancreatectomy, and 8% via distal
pancreatectomy. Twenty-two patients (37%) had IPMNs with an associated
infiltrating adenocarcinoma. In a subset of IPMNs immunohistochemically
stained for the Dpc4 protein (n = 50), all of the intraductal or
noninvasive components strongly expressed Dpc4, whereas 84% of
associated infiltrating cancers expressed Dpc4. The 5-year survival rate
for all patients with IPMNs (n = 60) was 57%. CONCLUSION: Intraductal
papillary mucinous neoplasms represent a distinct clinicopathologic
entity being recognized with increasing frequency. IPMNs are clinically,
histologically, and genetically disparate from pancreatic ductal
adenocarcinomas. The distinct clinical features, the presumably long in
situ or noninvasive phase, and the good long-term survival of patients
with IPMNs offer a unique opportunity for early diagnosis, curative
resection, and further studies of the molecular genetics and natural
history of these unusual neoplasms.
10
UI - 21415382
AU - Balcom JH 4th; Keck T; Warshaw AL; Antoniu B; Graeme-Cook F;
TI -
Fernandez-del Castillo C
Telomerase activity in periampullary tumors correlates with aggressive
malignancy.
SO - Ann Surg 2001 Sep;234(3):344-50; discussion 350-1
AD - Department of Surgery, Massachusetts General Hospital and Harvard
Medical School, Boston, Massachusetts 02114, USA.
OBJECTIVE: To determine the presence of telomerase activity in a variety
of periampullary malignancies and pancreatic diseases and quantify its
activity to establish any association with the stage or aggressiveness
of malignancy. SUMMARY BACKGROUND DATA: Progressive shortening of
telomeres, repetitive DNA sequences at the ends of chromosomes, plays a
role in cell senescence. Telomerase catalyzes conservation of telomeric
repeats and may promote cell immortality and hence malignancy. It is
absent in normal tissues but upregulated in more than 80% of cancers.
METHODS: Fresh specimens of 62 periampullary tumors were snap-frozen in
liquid nitrogen and adjacent tissue was formalin-fixed for
histopathology. The telomerase repeat amplification protocol (TRAP) was
used to obtain telomerase DNA products. These were separated with gel
electrophoresis, stained with SYBR green, and quantified by
densitometry. Findings were confirmed with a fluorometric TRAP assay in
which fluorescent primers specific for telomerase were selectively
amplified in its presence. RESULTS: Telomerase activity was upregulated
in 26 of 33 periampullary malignancies (79%): 17 of 21 pancreatic
adenocarcinomas (81%), 2 of 2 cholangiocarcinomas, 2 of 2 duodenal
carcinomas, and 5 of 8 ampullary carcinomas (63%). Poorly differentiated
periampullary tumors had significantly higher telomerase activity than
well-differentiated tumors, and tumors larger than 2 cm had
significantly higher telomerase activity than those 2 cm or smaller.
Pancreatic ductal adenocarcinomas with lymph node metastases had
significantly greater activity than node-negative cancers. Two of 11
intraductal papillary mucinous tumors were positive for telomerase
activity, but only in foci of invasive carcinoma. Chronic pancreatitis
(n = 7), serous cystadenomas (n = 5), benign mucinous cystic neoplasms
(n = 4), neuroendocrine cancer (n = 1), and acinar cell carcinoma (n =
1) had no detectable telomerase activity. CONCLUSION: Telomerase
activity is common in periampullary carcinomas. The magnitude of
activity correlates with aggressiveness in pancreatic adenocarcinoma and
may prove useful as a molecular index for biologic staging.
11
UI - 21438993
AU - Eibl G; Wente MN; Reber HA; Hines OJ
TI -
Peroxisome proliferator-activated receptor gamma induces pancreatic
cancer cell apoptosis.
SO - Biochem Biophys Res Commun 2001 Sep 21;287(2):522-9
AD - Gastrointestinal Surgery Section, Division of General Surgery, UCLA
School of Medicine, 72-215 CHS, 10833 LeConte Avenue, Los Angeles,
California 90095-6904, USA.
Peroxisome proliferator-activated receptor gamma (PPAR-gamma) decreases
the growth of certain cancer cells. In the present study, we found that
six different human pancreatic cancer cell lines (AsPC-1, BxPC-3,
Capan-2, HPAF-II, MIA PaCa-2, and PANC-1) expressed PPAR-gamma m-RNA and
synthesized the protein. The endogenous and exogenous PPAR-gamma ligands
15-deoxy-d12,14-prostaglandin J(2) (15-PGJ(2)) and ciglitazone decreased
cell number, cell viability, and increased floating/attached ratio, in a
time- and dose-dependent fashion. 15-PGJ(2) increased intracellular
nucleosome concentration after 6 h, but did not increase caspase-3
activity even after 96 h. Combined treatment with both 15-PGJ(2) and the
caspase-3 inhibitor DEVD-CHO had no effect on cell viability, but the
general caspase inhibitor ZVAD-FMK reduced 15-PGJ(2)-induced apoptosis.
We concluded that the six human pancreatic cancer cells tested all
expressed PPAR-gamma receptor, and treatment with PPAR-gamma agonists
decreased cell viability and growth in a time- and dose-dependent
manner. These effects were partially mediated by induction of caspase-3
independent apoptosis. Copyright 2001 Academic Press.
12
UI - 21459498
AU - Collins BT; Saeed ZA
TI -
Fine needle aspiration biopsy of pancreatic endocrine neoplasms by
endoscopic ultrasonographic guidance.
SO - Acta Cytol 2001 Sep-Oct;45(5):905-7
13
UI - 21466978
AU - Novotny J; Petruzelka L; Vedralova J; Kleibl Z; Matous B; Juda L
TI -
Prognostic significance of c-erbB-2 gene expression in pancreatic cancer
patients.
SO - Neoplasma 2001;48(3):188-91
AD - Department of Oncology, 1st Faculty of Medicine, Charles University and
General Teaching Hospital, Prague, Czech Republic.
novotny-2000@yahoo.com
Molecular methods tend to belong to the standard armamentarium of modern
pathology. In some instances, these methods are able to identify
nosological entities with better accuracy than conventional technique.
These methods give useful complementary information to choose
appropriate therapeutic strategy. C-erbB-2 overexpression in pancreatic
cancer vary widely between 17 to 82%. C-erbB-2 gene is perspective
target of anticancer therapies. 57 histologically confirmed tumors (51
pancreatic adenocarcinoma, 5 pancreatic neuroendocrine tumors and 1
carcinoma of Vater's ampullae) were analyzed for the presence of
c-erbB-2 expression by immunohistochemistry. Correlation with time from
initial symptoms until diagnosis, tumor size and TNM stage at diagnosis,
tumor grade, type of operation and overall survival were investigated.
C-erbB-2 overexpression was detected in 19.6% samples of pancreatic
adenocarcinoma and in one case of Vater's ampullae carcinoma. C-erbB-2
overexpression was found in two of four insulinomas. Univariate
statistical correlation stage between c-erbB-2 overexpression and time
from initial symptoms until diagnosis, tumor size and TNM at diagnosis,
tumor grade, type of operation and overall survival did not reach
statistical significans in any parameter studied. C-erbB-2 oncogene was
not found to be prognostic factor in pancreatic cancer. Its value to
predict therapeutical response remains to be determined in prospective
clinical trials.
14
UI - 21341705
AU - Seki K; Suda T; Aoyagi Y; Sugawara S; Natsui M; Motoyama H; Shirai Y;
TI -
Sekine T; Kawai H; Mita Y; Waguri N; Kuroiwa T; Igarashi M; Asakura H
Diagnosis of pancreatic adenocarcinoma by detection of human telomerase
reverse transcriptase messenger RNA in pancreatic juice with sample
qualification.
SO - Clin Cancer Res 2001 Jul;7(7):1976-81
AD - Department of Molecular Genetics, Graduate School of Medical and Dental
Sciences, Niigata University, Niigata 951-8122, Japan.
PURPOSE: We evaluated the diagnostic efficacy of detection of human
telomerase reverse transcriptase (hTERT) message, a catalytic domain of
human telomerase, in endoscopic retrograde pancreatography (ERP)-derived
pancreatic juice. EXPERIMENTAL DESIGN: Both hTERT and CD25 expression
were detected by reverse transcription-PCR (RT-PCR) in 17 patients with
pancreatic adenocarcinoma (PC), 12 patients with chronic pancreatitis
(CP), and 7 patients with no ERP abnormality (N). In the same patients,
beta-actin message was semiquantified by competitive RT-PCR. K-ras codon
12 mutations were concomitantly analyzed by enriched PCR-SSCP in 11 and
7 PC and CP cases, respectively. RESULTS: Expression of hTERT was
detected in 88% of PC cases and 17% of CP cases but not in the normal
control (N). Alterations in K-ras were detected in 73% of PC cases and
57% of CP cases, respectively. beta-Actin mRNA was expressed in >3.0 x
10(1) copies/microl in all but two PC cases in which hTERT mRNA was not
detected. CD25-positive and -negative peripheral lymphocytes were
isolated from a normal volunteer using a fluorescent activating cell
sorter. The hTERT message was detected in CD25-positive peripheral
lymphocytes and in 18, 25, and 0% of the pancreatic juice samples from
PC, CP, and N cases, respectively. All CP cases expressing hTERT message
were also CD25 positive. CONCLUSIONS: These results suggest that
detection of hTERT mRNA in pancreatic juice is a powerful tool to
discriminate PC from CP, particularly when the samples are qualified
against beta-actin mRNA levels and contaminating CD25-positive
lymphocytes.
15
UI - 21473977
AU - Brandle M; Pfammatter T; Spinas GA; Lehmann R; Schmid C
TI -
Assessment of selective arterial calcium stimulation and hepatic venous
sampling to localize insulin-secreting tumours.
SO - Clin Endocrinol (Oxf) 2001 Sep;55(3):357-62
AD - Division of Endocrinology and Diabetes, Department of Internal Medicine,
University Hospital Zurich, Switzerland. mbrandle@umich.edu
OBJECTIVE: Non-invasive localization modalities such as ultrasound,
computed tomography (CT) or magnetic resonance imaging (MRI) often fail
to localize insulinomas smaller than 2 cm in diameter. Recent studies
have shown that the selective arterial stimulation and hepatic venous
sampling (ASVS) technique using intra-arterial calcium as the insulin
secretagogue facilitates the regionalization of such occult insulinomas.
This study assesses the sensitivity of ASVS in localizing
insulin-secreting tumours. SUBJECTS AND METHODS: Eleven consecutive
patients (8 women), aged 29-82 years, were studied over the past 4 years
at our hospital. Hyperinsulinaemic hypoglycaemia due to an
insulin-secreting tumour was proven in all patients. Calcium gluconate
(0.025 mEq/kg body weight) was injected directly into the arteries
supplying the pancreas and the liver. Insulin levels were measured in
samples taken from the right hepatic vein before and 30, 60 and 120 s
after each injection. The ASVS technique was performed in all 11
patients; the results were compared with the surgical findings in 10
patients and the autopsy findings in 1 case. The ASVS results were also
compared with the findings of other, previously performed imaging
modalities. RESULTS: ASVS correctly localized 4 insulin-secreting
tumours to the head, 3 to the body, 1 to the tail, 2 to the tail or body
of the pancreas and 1 to the liver. Thus, the sensitivity was 100%
(11/11) whereas other localization techniques were less sensitive: 7/11
tumours were detected by angiography, 4/8 by endosonography, 3/8 by CT
and 1/6 by MRI. Insulinomas (confirmed by histological examination),
sized 4-25 mm, were found in 10 patients. All were cured by selective
surgery and remained free of hypoglycaemia over the next 1-4 years of
follow-up. An insulin-secreting neuroendocrine tumour in the liver was
documented in 1 case at autopsy. CONCLUSIONS: Arterial stimulation and
hepatic venous sampling is a very sensitive technique for preoperative
localization of insulin-producing tumours. It can help to plan minimally
invasive surgery and to select an appropriate strategy for patients
suffering from malignant tumours in others.
16
UI - 95025394
AU - Haddad A
TI -
Ethics in action: a biopsy showed that an 80-year-old woman--who's
usually lucid--has pancreatic cancer.
SO - RN 1994 Sep;57(9):15-7
17
UI - 21233218
AU - Balci NC; Semelka RC
TI -
Radiologic diagnosis and staging of pancreatic ductal adenocarcinoma.
SO - Eur J Radiol 2001 May;38(2):105-12
AD - Department of Radiology, Florence Nightingale Hospital, Istanbul,
Turkey. ncbalci@hotmail.com
This article presents imaging modalities in the diagnosis and staging of
pancreatic ductal adenocarcinoma. Magnetic resonance imaging (MRI) and
endoscopic ultrasonography (EUS) have the highest accuracy in detection
of pancreatic cancer. MRI and EUS have similar accuracy in determining
the local extent of pancreatic cancer. Angiography, computed tomography
(CT) angiography and EUS are similarly accurate in evaluating
peripancreatic vascular involvement. MRI is the superior method for
detecting liver metastases and peritoneal implants of pancreatic ductal
adenocarcinoma. Endoscopic retrograde cholangiopancreatography (ERCP)
and magnetic resonance cholangiopancreatography (MRCP) are used to
assess the biliary tract of patients with pancreatic cancer. Positron
emission tomography (PET) is useful in distinguishing pancreatic cancer
from focal pancreatic inflammation.
18
UI - 21233219
AU - Balci NC; Semelka RC
TI -
Radiologic features of cystic, endocrine and other pancreatic neoplasms.
SO - Eur J Radiol 2001 May;38(2):113-9
AD - Department of Radiology, Florance Nightingale Hospital, Istanbul,
Turkey. ncblci@hotmail.com
This article presents imaging features of cystic, endocrine and other
pancreatic neoplasms. Microcystic adenoma which is composed of small
cysts (<2 cm), its macrocystic subgroup contains solitary cyst. Multiple
cysts larger than 2 cm are associated with mucinous cystic neoplasm.
Swiss cheese appearence with central calcification is characteristic for
microcystic adenomas. Septal and mural enhancement as well as larger
size (>2 cm) are accounted for mucinous cystic neoplasms, its variant
along pancreatic duct is ductectatic mucinous cystic neolasm. Endocrine
tumors of pancreas are hypervascular and can be depicted on early
dynamic enhanced crosssectional imaging modalities or on angiography
when they are <1 cm. Pancreatic metastases and lymphomas are rare
neoplasms which should also be included in differential diagnosis for
pancreatic masses.
19
UI - 21233222
AU - Piironen A; Kivisaari R; Laippala P; Poutanen VP; Kivisaari L
TI -
Pancreatic carcinoma and fast MR imaging: technical considerations for
signal intensity difference measurements.
SO - Eur J Radiol 2001 May;38(2):137-45
AD - Department of Radiology, Tampere City Hospital, Tampere, Finland.
The aim of the study was to find the fast magnetic resonance imaging
(MRI) sequence with the best conspicuity of pancreatic lesions at 1.0 T
and 1.5 T. A total of 51 patients were studied. At 1.0 T, 22 patients
with verified malignant pancreatic lesions were studied using the
T1-weighted breath-hold spoiled Gradient Echo 2D FLASH(75) or FLASH(80)
sequences, both non-enhanced and enhanced with gadolinium. The relative
signal intensity difference (SIDR) between lesion and pancreas was
measured. At 1.5 T, 20 patients with primary malignant lesions of the
pancreas, and nine patients with 13 benign cystic lesions were examined
with the breath-hold T2-weighted TrueFISP, HASTE, T1-weighted 2D
FLASH(80) and FLASH(50) fat saturation sequences, the latter also
enhanced. The signal intensity (SI) values of the pancreas and lesions
as well as the pancreatic standard deviation (S.D.) were assessed, and
the contrast-to-noise ratio (C/N) was determined. Statistical
significances were calculated using an analysis of variance. No
statistically significant difference between the sequences used in the
conspicuity of cancer was found, either at 1.0 T or at 1.5 T. At 1.5 T,
the T2-weighted TrueFISP and HASTE sequences could differentiate benign,
cystic lesions from malignant lesions.
20
UI - 21233223
AU - Obuz F; Dicle O; Coker A; Sagol O; Karademir S
TI -
Pancreatic adenocarcinoma: detection and staging with dynamic MR
imaging.
SO - Eur J Radiol 2001 May;38(2):146-50
AD - Dokuz Eylul University School of Medicine, Department of Radiology,
Izmir, Turkey. fobuz@deu.edu.tr
OBJECTIVE: To compare the efficacy of dynamic contrast-enhanced MR
imaging and spin-echo T1-weighted with and without fat-saturated MR
imaging in the detection and staging of pancreatic adenocarcinoma.
METHODS AND MATERIAL: Spin-echo T1-weighted, fat-saturated T1-weighted
and dynamic breath-hold 2D-FLASH MR imaging were performed in 25
patients with pancreatic adenocarcinoma. MR images were analysed by
calculating the CNR between tumor and normal portion of the pancreas.
The CNRs calculated at each sequences were compared. A total of 16 out
of 25 patients underwent surgery. Preoperative staging according to TNM
classification was also done in patients undergoing surgery. RESULTS:
The CNR was significantly different (P<0.05) in the arterial phase of
dynamic MR images. The accuracy of 'T' staging was 75% for SE T1-W,
fat-saturated T1-W and arterial phase of dynamic MR images. CONCLUSION:
The CNRs between pancreatic carcinoma and normal pancreas is
significantly higher in dynamic MR sequences than the SE T1-W,
fat-saturated T1-W sequences. However, the accuracy of tumor staging
according to TNM is equivocal to SE T1-W and fat-saturated T1-W images.
21
UI - 21233224
AU - Arslan A; Buanes T; Geitung JT
TI -
Pancreatic carcinoma: MR, MR angiography and dynamic helical CT in the
evaluation of vascular invasion.
SO - Eur J Radiol 2001 May;38(2):151-9
AD - Department of Radiology, Kocaeli University Hospital, Izmit, Turkey.
arzuarslan@netscape.net
OBJECTIVE: To assess the value of MR angiography in combination with
contrast-enhanced MR imaging, and to compare MR imaging including MR
angiography with dynamic contrast-enhanced dual phase helical CT in the
preoperative assessment of vascular invasion in patients with suspected
pancreatic carcinoma. METHODS AND MATERIAL: MR imaging only, MR imaging
including MR angiography and dynamic contrast-enhanced dual phase
helical CT images of 48 patients who were operated due to suspicion of
pancreas cancer were correlated with the surgery results in terms of
vascular invasion. Pathologic diagnosis were pancreatic adenocarcinoma
in 31 patients of which nine had surgically confirmed vascular invasion.
Sensitivity, specificity, predictive values (including 95% confidence
intervals) and accuracy of MR imaging only, MR imaging including MR
angiography and helical CT were calculated. RESULTS: Sensitivity,
specificity, positive and negative predictive values and accuracy were
56, 100, 100, 85, 87%; 67, 100, 100, 88, 90% and 67, 100, 100, 88, 90%,
respectively, for MR imaging only, MR imaging including MR angiography
and helical CT in the adenocarcinoma group. The corresponding figures in
the overall study group were 56, 97, 83, 90, 90%; 67, 97, 86, 93, 92%
and 67, 97, 86, 93, 92%. Confidence intervals (95%) showed that the
differences in the diagnostic efficacy of the techniques were not
statistically significant in the overall study group, but the confidence
intervals were undefined in the adenocarcinoma group due to the small
sample size. CONCLUSION: Diagnostic efficacy of MR imaging when combined
with MR angiography is equal to that of dynamic contrast-enhanced dual
phase helical CT in the assessment of vascular invasion of pancreatic
tumors.
22
UI - 21323621
AU - Jadvar H; Fischman AJ
TI -
Evaluation of pancreatic carcinoma with FDG PET.
SO - Abdom Imaging 2001 May-Jun;26(3):254-9
AD - Division of Nuclear Medicine, Department of Radiology, Massachusetts
General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA
02114, USA.
BACKGROUND: To assess the diagnostic usefulness and clinical impact of
positron emission tomography with [F-18]fluorodeoxyglucose (FDG PET) on
the management of patients with known or suspected pancreatic carcinoma.
METHODS: Attenuation-corrected FDG PET was performed in 20 patients (12
male, eight female) with pancreatic carcinoma at the time of initial
diagnosis (n = 7), for tumor surveillance after Whipple surgery (n =
11), and for reevaluation after chemoradiation therapy (n = 2). Visual
analysis of PET images were correlated with the results of abdominal
computed tomography (CT) and carbohydrate antigen (CA) 19-9 serum tumor
marker level that were obtained within 1 month of the PET study.
Diagnostic validation was by histology in nine patients and by clinical
or radiologic follow-up (5-48 months) in 11 patients. Changes in
therapeutic management that were prompted by PET were tabulated.
RESULTS: PET was concordant with the findings of abdominal CT in 14
patients (13 true positive, 1 true negative). PET detected clinically
unsuspected lung lesions, confirmed subsequently by a chest CT, in one
of these 14 patients. PET was discordant with CT in six patients. PET
detected tumor recurrence in three patients in this group (15% of total)
with nondiagnostic CT findings and elevated CA 19-9 serology. In two of
these three patients, chemotherapy with gemcitabine was initiated based
on PET localization of disease. Tumor was confirmed in the remaining one
of the three patients at autopsy shortly after the PET study. FDG
localization in a displaced loop of bowel resulted in an apparent
false-positive hepatic lesion in one of six patients in the discordant
group. PET underestimated the extent of metastatic disease in the
remaining two of six patients due to hyperglycemia. CONCLUSION: In
patients with suspected pancreatic carcinoma at the time of initial
presentation, PET is complementary to abdominal CT and allows detection
of unsuspected distant metastases. In patients with suspected recurrent
pancreatic carcinoma, based on elevated or rising CA 19-9 serology, PET
can localize the disease when abdominal CT is nondiagnostic as a result
of posttherapy anatomic alteration. Imaging evaluation with PET may
impact the clinical management of patients with pancreatic carcinoma.
23
UI - 21321390
AU - Otani T; Makuuchi M
TI -
Potter type III cystic disease and pancreatic malignancies.
SO - J Gastroenterol 2001;36(6):438-40
24
UI - 21523834
AU - Hanley AJ; Johnson KC; Villeneuve PJ; Mao Y; Canadian Cancer Registries
TI -
Epidemiology Research Group
Physical activity, anthropometric factors and risk of pancreatic cancer:
results from the Canadian enhanced cancer surveillance system.
SO - Int J Cancer 2001 Oct 1;94(1):140-7
AD - Division of Epidemiology and Biostatistics, Samuel Lunenfeld Research
Institute, Mt. Sinai Hospital, 850-600 University Ave., Toronto,
Ontario, M5G 1X5, Canada. hanley@mshri.on.ca
To explore the hypothesis that insulin resistance may be an etiologic
factor in pancreatic cancer, we assessed the pancreatic cancer risk
associated with anthropometric factors and physical activity, both of
which are important determinants of insulin sensitivity in humans. Three
hundred and twelve patients with histologically confirmed pancreatic
cancer were compared to 2,919 controls in a population-based,
case-control study in 7 of the 10 Canadian provinces. Participants were
asked to report their exposure status for the period 2 years before
interview. Men in the highest quartile of body mass index (BMI, > or
=28.3 kg/m(2)) were at increased risk of pancreatic cancer [adjusted
odds ratio (OR) = 1.90, 95% confidence interval (CI) 1.08-3.35]. In
addition, men who reported a decrease in weight of at least 2.9% from
their lifetime maximum were at reduced risk compared to those reporting
a < or =2.9% loss (> or =10.2% loss, OR = 0.51, 95% CI 0.30-0.86). BMI 2
years before interview was not associated with pancreatic cancer risk
among women, though those reporting a > or =12.5% decrease in weight
from their lifetime maximum had substantially lower risk compared to
those in the baseline quartile (OR = 0.53, 95% CI 0.29-0.99). After
adjustment for age, province of residence, dietary intake and
anthropometric factors, men in the highest quartile of the composite
moderate and strenuous physical activity index were at reduced risk of
pancreatic cancer (OR = 0.53, 95% CI 0.31-0.90). Physical activity did
not appear to be associated with pancreatic cancer among women, though a
tendency for reduced risk with increasing levels of strenuous activity
was suggested (p for trend = 0.06). Our findings support the hypothesis
that insulin resistance is an etiologic factor in the development of
pancreatic neoplasms among men and possibly women. Copyright 2001
Wiley-Liss, Inc.
25
UI - 21444241
AU - Kullavanijaya P; Treeprasertsuk S; Thong-Ngam D; Kladcharoen N; Mahachai
TI -
V; Suwanagool P
Adenocarcinoma of the pancreas: the clinical experience of 45
histopathologically proven patients, a 6 year study.
SO - J Med Assoc Thai 2001 May;84(5):640-7
AD - Department of Medicine, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand.
A retrospective study of 45 cases of adenocarcinoma of the pancreas at
Chulalongkorn University Hospital from 1993 to 1998 was reviewed by
clinical and histopathological criteria. Male and female ratio was
25:20. The mean age of the patients was 59.5 +/- 10.0 years. The common
presenting symptoms and signs were epigastric discomfort (80.0%), weight
loss (60.0%) and jaundice (51.1%). Twenty four patients (53.3%) were
screened for a tumor marker (CA 19-9) and 87.5 per cent of these had
high level of CA 19-9 (> 37 IU/ml). Thirty five patients (77.8%) had
tumors located in the head of the pancreas. Most of the cases were
investigated by using radiological imaging (ultrasonography or
computerized tomography of the abdomen). Thirty five histopathological
data (77.8%) were made by the operation, and the rest (22.2%) were
performed by a fine needle aspiration from the pancreatic mass or liver
metastasis. Whipple operation and the bypass procedure were the most
common surgical procedures in our studies. Twenty five patients (55.6%)
had post treatment complications from all modalities consisting of
gastrointestinal bleeding, respiratory failure and infection. However,
the mortality rate within 30 days postoperatively was 8.11 per cent
which was due to blood loss during the operation and infections. The
post treatment mortality rate from all modalities was 33.3 per cent. The
average duration from the diagnosis until death was 82.3 days.
26
UI - 21451485
AU - Ahmad NA; Lewis JD; Ginsberg GG; Haller DG; Morris JB; Williams NN;
TI -
Rosato EF; Kochman ML
Long term survival after pancreatic resection for pancreatic
adenocarcinoma.
SO - Am J Gastroenterol 2001 Sep;96(9):2609-15
AD - Department of Medicine, Center for Clinical Epidemiology and
Biostatistics, University of Pennsylvania Cancer Center, Philadelphia,
Pennsylvania, USA.
OBJECTIVE: The aim of this study was to determine the long term survival
of patients with pancreatic adenocarcinoma who underwent surgical
resection and to assess the association of clinical, pathological, and
treatment features with survival. METHODS: Between January, 1990, and
December, 1998, 125 patients underwent a pancreaticoduodenal or partial
pancreatic resection for pancreatic ductal adenocarcinoma at our
institution. The records of these patients were reviewed for
demographics, tumor characteristics including size, histological grade,
margin status, lymph node status, surgical TNM staging, and
postoperative adjuvant therapy. The primary outcome variable analyzed
was survival. RESULTS: A total of 116 patients had complete follow-up
and were included in the final analysis. The median survival after
surgery was 16 months. The 1-, 3-, 5-, and 7-yr survival rates for all
116 patients were 60%, 23%, 19%, and 11%, respectively. The 1-, 3-, 5-,
and 7-yr survival rates for patients who received adjuvant therapy were
69%, 28%, 23%, and 18% compared with 20% and 0% in patients who did not
receive adjuvant therapy (p < 0.0001). The 1-, 3-, 5-, and 7-yr survival
rates for patients with negative lymph nodes were 73%, 38%, 26%, and 22%
compared with survival rates of 52%, 14%, 14%, and 9% in patients with
positive lymph nodes (p = 0.01). In multivariate analyses, adjuvant
therapy was the only feature found to be strongly associated with
survival (hazards ratio = 0.26, 95% CI = 0.15-0.44). CONCLUSIONS: The
overall 5- and 7-yr survival rates of 19% and 11% in our study further
validate that surgical resection in patients with pancreatic
adenocarcinoma can result in long term survival, particularly when
performed in association with adjuvant chemoradiation.
27
UI - 21451492
AU - Harewood GC; Wiersema MJ
TI -
A cost analysis of endoscopic ultrasound in the evaluation of pancreatic
head adenocarcinoma.
SO - Am J Gastroenterol 2001 Sep;96(9):2651-6
AD - Developmental Endoscopy Unit, Mayo Clinic, Rochester, Minnesota 55905,
USA.
OBJECTIVE: Endoscopic ultrasound (EUS)-guided fine needle aspiration
(FNA) biopsy of nonperitumoral (NPT) lymph nodes (LN) can be helpful in
preoperative staging of pancreatic head adenocarcinoma. The economic
impact of this staging strategy has not yet been described. The aim of
this study was to apply a decision analysis model to compare the costs
of three approaches to the management of nonmetastatic pancreatic head
adenocarcinoma: EUS FNA versus CT-guided FNA versus surgery. A cost
minimization approach was employed, as viewed from the perspective of
the payer. METHODS: A decision analysis model was designed using DATA
Version 3.5, taking the entry criteria as "resectable" pancreatic head
adenocarcinoma as determined by helical CT. Detection of metastatic NPT
LN on FNA signified unresectability and obviated the need for surgery.
Baseline probabilities were varied through plausible ranges using
sensitivity analysis. Cost inputs were based on Medicare professional
plus facility fees. The endpoint was cost of management per patient.
RESULTS: EUS FNA was the least costly strategy ($15,938) compared with
CT FNA ($16,378) and surgery ($18,723). Sensitivity analysis revealed
that EUS FNA remained the least costly option provided the frequency of
NPT LN involvement was >4%; below this value, surgery became the least
costly. CONCLUSIONS: EUS FNA is the least costly staging strategy in the
workup of patients with nonmetastatic pancreatic head adenocarcinoma
primarily because of confirmation of NPT LN involvement avoiding
unnecessary surgery. These results support performing EUS in patients
whose tumors are thought to be resectable on helical CT to enhance NPT
LN assessment.
28
UI - 21453909
AU - Ichikawa T; Sou H; Araki T; Arbab AS; Yoshikawa T; Ishigame K; Haradome
TI -
H; Hachiya J
Duct-penetrating sign at MRCP: usefulness for differentiating
inflammatory pancreatic mass from pancreatic carcinomas.
SO - Radiology 2001 Oct;221(1):107-16
AD - Department of Radiology, Yamanashi Medical University, 1110 Shimokato,
Tamaho, Nakakoma, Yamanashi 409-3815, Japan.
ichikawa@res.yamanahi-med.ac.jp
PURPOSE: To define the duct-penetrating sign at magnetic resonance (MR)
cholangiopancreatography (MRCP) and to assess the usefulness of this
sign for distinguishing an inflammatory pancreatic mass (IPM) from a
conventional pancreatic carcinoma (CPC) compared with arterial phase
comp
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