National Cancer Institute®
Last Modified: May 1, 2002
UI - 11894319
AU - Wilson H; Butler LJ; Repetto G; Love J
TI - Providing care to patients with pancreatic cancer: a retrospective chart review.
SO - Can Oncol Nurs J 2000 Fall;10(4):134-8
AD - QEII Health Sciences Centre, Halifax.
Pancreatic cancer may be considered rare, yet in Canada it is the fourth leading cause of death by cancer in the elderly. This study was conducted in a large tertiary centre to determine the symptoms experienced by patients and the response by health professionals in providing supportive care. This paper reports the results of a retrospective review of health records from patients diagnosed with pancreatic cancer (n = 99). Results indicate that pain, nausea, vomiting, and anorexia were frequently reported. There was a lack of consistency in the documentation of nursing care and little evidence of an organized, planned approach for care delivery. The role of the interdisciplinary health care team and its members in managing this devastating disease and its impact on patient quality of life was difficult to ascertain. The development of an integrated approach to the care of patients with pancreatic cancer is presented.
UI - 11967685
AU - Wong YT; Brams DM; Munson L; Sanders L; Heiss F; Chase M; Birkett DH
TI - Gastric outlet obstruction secondary to pancreatic cancer: surgical vs endoscopic palliation.
SO - Surg Endosc 2002 Feb;16(2):310-2
AD - Department of General Surgery, Lahey Clinic, 41 Mall Road, Burlington, MA 01805, USA. firstname.lastname@example.org
BACKGROUND: Gastric outlet obstruction in patients with pancreatic cancer has a grim prognosis. Open surgical bypass is associated with high morbidity, whereas endoscopic duodenal stenting appears to provide better palliation. METHODS: We reviewed the medical records of patients with gastric outlet obstruction secondary to pancreatic carcinoma who 1998. The data included stage of disease, American Society of Anesthesiologists (ASA) class, surgical interventions, complications, and survival. RESULTS: A total of 250 patients with pancreatic cancer were identified. Twenty-five of them (10%) had gastric outlet obstruction. Of these 25, 17 were treated with gastrojejunostomy, six had duodenal stenting (Wallstent), and two were resectable. There was no significant difference between the gastrojejunostomy group and the duodenal stenting group in ASA class or stage of disease. For the gastrojejunostomy group, median survival was 64 days (range, 15-167) and postoperative stay in hospital was 15 days (range, 8-39). For the duodenal stenting group, median survival was 110.5 days (range, 42-212) and postoperative stay was 4 days (range, 2-6). Ten patients (58.8%) in the gastrojejunostomy group had delayed gastric emptying. All of the patients in the duodenal stenting group were able to tolerate a soft diet the day after stent placement. Thirty-day mortality in the gastrojejunostomy group was 17.64%; in the duodenal stenting group, it was 0. CONCLUSION: In pancreatic carcinoma patients with gastric outlet obstruction, duodenal stenting results in an earlier discharge from hospital and possibly improved survival.
UI - 11910485
AU - Park SJ; Kim SW; Jang JY; Lee KU; Park YH
TI - Intraoperative transfusion: is it a real prognostic factor of periampullary cancer following pancreatoduodenectomy?
SO - World J Surg 2002 Apr;26(4):487-92
AD - Department of Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
The purpose of this study was to clarify the prognostic significance of transfusion following pancreatoduodenectomy for periampullary cancers. We analyzed 357 periampullary cancers from 1985 to 1997 (ampullary cancer 130 cases, distal bile duct cancer 141 cases, pancreatic head cancer 86 cases). A total of 215 (60%) of the 357 patients have received intraoperative transfusion. The 5-year survival rate of 130 ampullary cancer patients was 59%; altogether, 76 patients (58%) underwent intraoperative transfusion. The 5-year survival rate of patients without intraoperative transfusion was 79%, whereas that of patients with a transfusion was 47% (p = 0.029). Following multivariate analysis, intraoperative transfusion was found to be an independent poor prognostic factor for those with ampullary cancer (relative risk 2.174). Among those with common bile duct cancer, the overall 5-year survival rate was 33%, and the 5-year survival rates for patients with (n = 87) or without (n = 54) transfusion were 25% and 38%, respectively, which did not reach statistical significance (p = 0.0717). For those with pancreatic head cancer, the overall 5-year survival rate was 16%, and there was no survival difference between transfused (n = 52) and untransfused (n = 34) patients. In the present study the reason was not clear, although intraoperative transfusion was an independent significant prognostic factor for ampullary cancer. Careful dissection to minimize intraoperative bleeding is mandatory during pancreatoduodenectomy for ampullary cancer.
UI - 11929809
AU - Lott ST; Chandler DS; Curley SA; Foster CJ; El-Naggar A; Frazier M;
TI - Strong LC; Lovell M; Killary AM High frequency loss of heterozygosity in von Hippel-Lindau (VHL)-associated and sporadic pancreatic islet cell tumors: evidence for a stepwise mechanism for malignant conversion in VHL tumorigenesis.
SO - Cancer Res 2002 Apr 1;62(7):1952-5
AD - Department of Molecular Genetics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
Germ-line mutation of the von Hippel-Lindau (VHL) gene predisposes to the development of multifocal, benign lesions, including retinal and central nervous system hemangioblastomas, pheochromocytomas, and renal and pancreatic cysts. Progression to malignancy in VHL disease is associated primarily with the development of renal cell carcinoma (RCC) and pancreatic islet cell tumors (PICT). Although many reports have documented the multiple functions of the VHL protein, few have investigated the intriguing question related to the tissue-specificity of malignant conversion in VHL disease, a problem not easily explained by strict genotype-phenotype correlations. We investigated a novel VHL kindred with a preponderance of PICTs to determine whether loss of additional genetic loci associated with the sporadic forms of RCC and PICTs might play a role in malignant conversion in this disease. We report the high frequency loss of heterozygosity (LOH) of genetic loci distinct from and mapping proximal to VHL within human chromosome 3p in the VHL kindred under study. Furthermore, chromosome 3p LOH occurs subsequent to VHL mutation and cyst formation, and correlates with malignant progression in VHL-associated PICTs. High frequency LOH was also observed in sporadic PICTs in regions of 3p associated with LOH in sporadic clear cell RCC as well as homozygous deletion in lung cancer. A stepwise model for malignant conversion in VHL disease is herein proposed.
UI - 11416115
AU - Stolzenberg-Solomon RZ; Blaser MJ; Limburg PJ; Perez-Perez G; Taylor PR;
TI - Virtamo J; Albanes D; ATBC Study Helicobacter pylori seropositivity as a risk factor for pancreatic cancer.
SO - J Natl Cancer Inst 2001 Jun 20;93(12):937-41
AD - Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics and Cancer Prevention Studies Branch, Division of Clinical Sciences, National Cancer Institute, Bethesda, MD 20892, USA. email@example.com
BACKGROUND: Pancreatic cancer is among the most fatal cancers worldwide and one for which few preventable risk factors have been established. Gastric carriage of Helicobacter pylori, particularly cytotoxin-associated gene-A-positive (CagA+) strains, is known to be a risk factor for peptic ulcer disease and gastric cancer and may have a similar etiologic relationship with pancreatic cancer. METHODS: We investigated the association of H. pylori carriage and exocrine pancreatic cancer in a nested case-control study within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study cohort of 29 133 male Finnish smokers aged 50-69 years at baseline. Case subjects (n = 121) were matched on date of baseline serum collection, study center, age, trial intervention, and completion of the dietary questionnaire to 226 control subjects who were alive at the time the matching case subject was diagnosed and who remained free of cancer, during up to 10 years of follow-up. Levels of immunoglobulin G antibodies to H. pylori whole-cell and CagA+ antigens from stored baseline serum were measured by enzyme-linked immunosorbent assay. Smoking-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by use of conditional logistic regression. Statistical tests were two-sided. RESULTS: Seroprevalence of H. pylori was 82% and 73% among case and control subjects, respectively. Compared with seronegative subjects, those with H. pylori or CagA+ strains were at statistically significantly elevated risk of pancreatic cancer (OR = 1.87 [95% CI = 1.05 to 3.34]; OR = 2.01 [95% CI = 1.09 to 3.70], respectively). CONCLUSIONS: Our findings support a possible role for H. pylori carriage in the development of exocrine pancreatic cancer.
UI - 11820412
AU - Lavonius MI; Laine S; Salo S; Sonninen P; Ovaska J
TI - Role of laparoscopy and laparoscopic ultrasound in staging of pancreatic tumours.
SO - Ann Chir Gynaecol 2001;90(4):252-5
AD - Department of Surgery, Turku University Central Hospital, Finland. firstname.lastname@example.org
BACKGROUND AND AIMS: Radiological imaging alone is not reliable enough in staging of pancreatic cancer. Not only because of poor sensitivity but also because there is a tendency to overstage tumours. The aim of the study was to compare the efficiency of spiral computed tomography (CT), transabdominal ultrasound (US), laparoscopy (LAP) and laparoscopic ultrasound (LUS) in staging of pancreatic tumours. MATERIAL AND METHODS: In this prospective study 27 patients underwent pancreatic tumour staging with CT, US, LAP and LUS. The reference standard was operative evaluation or in case of disseminated disease laparoscopic assessment. RESULTS AND CONCLUSIONS: Although LAP was hindered by adhesions in 11% of the patients the benefit of LAP staging was evident in detecting peritoneal carcinomatosis. The assessment of the local tumour expansion of a pancreatic carcinoma was difficult for all staging modalities. LUS did not change the decision whether to proceed with laparotomy once. In our experience routine use of laparoscopic staging does not benefit patients with pancreatic tumour but in selected cases it may prevent unnecessary laparotomy.
UI - 11920612
AU - Missiaglia E; Moore PS; Williamson J; Lemoine NR; Falconi M; Zamboni G;
TI - Scarpa A Sex chromosome anomalies in pancreatic endocrine tumors.
SO - Int J Cancer 2002 Apr 1;98(4):532-8
AD - Department of Pathology, Universita di Verona, Italy.
We have investigated the status of sex chromosomes in 40 pancreatic endocrine tumors (PETs) using 2 complementary techniques: microsatellite and interphase FISH analysis. Twenty-five tumors were from female and 15 from male patients and included 31 nonfunctioning and 9 functioning PET (6 insulinomas, 2 glucagonomas and 1 VIPoma). Microsatellite and FISH analysis showed concordant results in all cases. PETs from females showed frequent loss of chromosome X (40%) whereas PETs from males showed relatively frequent loss of chromosome Y (36%) but never loss of the X chromosome. Statistical analysis showed significant association of sex chromosome loss with metastases (Spearman correlation test, r = 0.5, p < 0.001), local invasion (r = 0.33, p < 0.05) and high proliferation rate measured as Ki-67 index with a 5% cut-off (r = 0.42, p < 0.02). The analysis also showed that local invasion and metastases were highly correlated (r = 0.86). Multivariate survival analysis was therefore carried out including local invasion and loss of sex chromosomes. The presence of local invasion increased the risk of death almost 9 times whereas sex chromosome loss was an independent variable associated with a shorter survival period and an increased risk of death of approximately 4-fold. Copyright 2002 Wiley-Liss, Inc.
UI - 11888712
AU - Reddy SK; Burton AW
TI - Re: video-assisted thoracoscopic sympathectomy-splanchnicectomy.
SO - J Pain Symptom Manage 2002 Mar;23(3):177; discussion 178
UI - 11960385
AU - Ueki T; Walter KM; Skinner H; Jaffee E; Hruban RH; Goggins M
TI - Aberrant CpG island methylation in cancer cell lines arises in the primary cancers from which they were derived.
SO - Oncogene 2002 Mar 27;21(13):2114-7
AD - Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, MD 21205-2196, USA.
A higher prevalence of epigenetic inactivation of tumor suppressor genes has been reported in cancer cell line populations compared to primary cancer populations. Cancer-related genes are commonly methylated in cancer cell lines but it is not known the extent to which tumor suppressor genes may be artificially methylated in vitro. We therefore examined 10 pancreatic cancer cell lines and corresponding primary tumors for aberrant DNA methylation of promoter CpG islands of eight genes and seven CpG islands. Using methylation-specific PCR (MSP), methylation was not detected at any of the 15 CpG islands in 15 normal pancreata or in an immortalized normal pancreatic duct epithelial (HPDE) cell line. Of 150 loci examined, 49 loci were methylated in both primary carcinomas and their corresponding cell lines, 95 loci were not methylated in either cell lines or their corresponding primary carcinomas. There were four loci methylated only in cell lines while another two loci were methylated only in primary carcinomas. Overall, the methylation status of primary carcinomas and their cell lines were concordant in 96% of cases (144 of 150) (J statistic; J=0.92, P<0.0001). We conclude that most of the DNA methylation of tumor suppressor genes observed in cancer cell lines is present in the primary carcinomas from which they were derived.
UI - 11964041
AU - Barth PJ; Ebrahimsade S; Hellinger A; Moll R; Ramaswamy A
TI - CD34+ fibrocytes in neoplastic and inflammatory pancreatic lesions.
SO - Virchows Arch 2002 Feb;440(2):128-33
AD - Institute of Pathology, Philipps University Marburg, Germany. email@example.com
Besides its function as a matrix-producing cell, the CD34+ fibrocyte has been reported to be an antigen-presenting cell capable of priming naive T cells in situ. Therefore, it has been claimed that the CD34+ fibrocyte may play an important role in host response to tissue damage. The objective of the present study was to analyze the presence and distribution of CD34+ fibrocytes and smooth muscle actin (SMA) reactive myofibroblasts in relation to the underlying pancreatic disease. We investigated a total of 12 pancreatic adenocarcinomas, 7 endocrine tumors of the pancreas, and 8 cases of chronic pancreatitis; in 11 cases, normal pancreatic tissue was available. The stroma of normal pancreatic tissue harbored diffusely scattered CD34+ fibrocytes. Chronic pancreatitis was characterized by an increased number of stromal CD34+ fibrocytes paralleled by a gain of SMA reactive myofibroblasts which were not observed in the normal pancreatic stroma. The stroma of pancreatic ductal adenocarcinomas and endocrine tumors was devoid of CD34+ fibrocytes or showed at least a focal loss of this cell type, whereas SMA reactive myofibroblasts were detected in both endocrine tumors and adenocarcinomas. We conclude that detection of CD34+ fibrocytes may constitute an adjunctive tool in distinguishing chronic pancreatitis from ductal adenocarcinoma since the absence of this cell population strongly favors a neoplastic process. Moreover, CD34+ fibrocytes and myofibroblasts appear to be involved in stromal remodeling associated with chronic pancreatitis and ductal adenocarcinoma.
UI - 11950919
AU - Klein WM; Hruban RH; Klein-Szanto AJ; Wilentz RE
TI - Direct correlation between proliferative activity and dysplasia in pancreatic intraepithelial neoplasia (PanIN): additional evidence for a recently proposed model of progression.
SO - Mod Pathol 2002 Apr;15(4):441-7
AD - Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA.
A growing body of morphological, clinical, and genetic observations suggests a progression model for pancreatic ductal adenocarcinoma. In this model, pancreatic ducts progress through a series of architectural and cytological changes that define degrees of pancreatic intraepithelial neoplasia (PanIN). Expressed in dividing cells, Ki-67 has been extensively used as a proliferation marker. Its expression in different grades of PanIN has not been well studied. A total of 76 PanINs from 41 patients were histologically graded according to recently established criteria. These PanINs were then immunolabeled with a monoclonal antibody against Ki-67 (Mib-1). Normal ducts and invasive ductal adenocarcinomas were also labeled with the antibody. In 15 normal ducts, only 0.41% of the epithelial cells expressed Ki-67. Ki-67-labeling indices in the increasing grades of PanIN were as follows: PanIN-1A, 0.69%; PanIN-1B, 2.33%; PanIN-2, 14.08%; and PanIN-3, 22.01%. Fifteen invasive ductal adenonocarcinomas showed an average labeling index of 36.99%. The difference in Ki-67 labeling among these groups was statistically significant (P <.0005, Kruskal-Wallis test). This pattern of proliferation provides additional evidence supporting the recently proposed pancreatic progression model. It also correlates well with known molecular changes, such as activating point mutations in the K-ras oncogene and the loss of DPC4 and p16 gene expression. Ki-67 staining may be useful as an adjunct in the diagnosis of precancerous lesions in the pancreas and may provide a reliable way to identify lesions at high risk for the subsequent development of infiltrating carcinoma.
UI - 11950922
AU - Schleger C; Verbeke C; Hildenbrand R; Zentgraf H; Bleyl U
TI - c-MYC activation in primary and metastatic ductal adenocarcinoma of the pancreas: incidence, mechanisms, and clinical significance.
SO - Mod Pathol 2002 Apr;15(4):462-9
AD - Institute of Pathology, Universitatsklinikum Mannheim, Germany. firstname.lastname@example.org
Amplification and overexpression of c-MYC is a common event in various neoplasias. Recently, comparative genomic hybridization (CGH) of primary pancreatic adenocarcinomas revealed a distinct high-level amplification of 8q23-qter, suggesting that c-MYC located on 8q24 may be a candidate oncogene. To evaluate the biological significance and prognostic value of c-MYC activation in pancreatic carcinoma, we performed interphase fluorescence in situ hybridization (FISH) and immunohistochemistry on a series of 69 primary pancreatic adenocarcinomas, 19 corresponding lymph node metastases, and 5 pancreatic intraductal lesions. Dual color FISH using a probe for c-MYC (8q24) and a centromeric probe for chromosome 8 revealed amplification of c-MYC in 32.3% and 29.4% of primary and metastatic tumors, respectively. Immunostaining identified c-MYC protein overexpression in 43.5% of primaries and 31.6% of metastases. Low concordance between positive FISH and immunostaining (13.4%) suggests multiple independent regulatory pathways of c-MYC activation. Statistical evaluation revealed significant correlation (alpha = 0.033) between c-MYC protein overexpression and histopathological tumor grade but absence of correlation with tumor stage or lymph node status. Analysis of pancreatic intraductal lesions showed c-MYC amplification and protein overexpression in two of five cases in which invasive carcinoma exhibited identical aberrations. We conclude that deregulation of c-MYC protein is common in pancreatic cancer and that it may be involved in early neoplastic development and progression rather than in locoregional spread of invasive cancer.
UI - 11964083
AU - Rudroff C; Seibold S; Kaufmann R; Zetina CC; Reise K; Schafer U;
TI - Schneider A; Brockmann M; Scheele J; Neugebauer EA Expression of the thrombin receptor PAR-1 correlates with tumour cell differentiation of pancreatic adenocarcinoma in vitro.
SO - Clin Exp Metastasis 2002;19(2):181-9
AD - Second Department of Surgery, University of Cologne, Germany. email@example.com
Patients with pancreatic cancer frequently suffer from thrombosis due to excess thrombin generation. Yet, the effects of thrombin on pancreatic cancer are still poorly understood. The thrombin receptor PAR-1 is responsible for cellular effects of thrombin. PAR-1 plays an important role in the progression of different solid tumours in vitro. In breast cancer the level of PAR-1 expression correlates with invasiveness. Our aim was to correlate PAR-1 mRNA and protein expression level with the grade of differentiation of pancreatic tissue and cancer cell lines. PAR-1 protein was not detectable in the epithelium of healthy pancreas. Analysis of PAR-1 protein expression by immunofluorescence staining of pancreatic cancer cell lines revealed a correlation to the grade of differentiation. Quantitative analysis of PAR-1 protein expression by Western Blot analysis confirmed these observations. Analysis of PAR-1 mRNA expression showed low levels in healthy pancreas compared to pancreatic cancer tissue and the pancreatic cancer cell line MIA PaCa-2. The level of PAR-1 mRNA differed up to 25 fold between the respective pancreatic cancer cell lines. The eminent differences in PAR-1 expression, both protein and mRNA, between healthy pancreatic tissue and pancreatic cancer in vivo and in vitro emphasise the putative role of PAR-1 in pancreatic cancer progression.
UI - 11836587
AU - Ueda T; Oda T; Kinoshita T; Konishi M; Nakahashi C; Takahashi S; Hasebe
TI - T; Fukao K; Ochiai A Neovascularization in pancreatic ductal adenocarcinoma: Microvessel count analysis, comparison with non-cancerous regions and other types of carcinomas.
SO - Oncol Rep 2002 Mar-Apr;9(2):239-45
AD - Pathology Division, National Cancer Center Research Institute East, Kashiwa, Chiba, Japan.
Although neovascularization is regarded as an essential factor for tumor growth, it is unclear whether pancreatic adenocarcinoma is also influenced by this process. Furthermore, the reported microvessel count (MVC) data can not be compared due to the diversity of evaluating methods, and the relation between MVC data and metastatic potentials remains controversial. A total of 24 pancreatic adenocarcinomas and 24 adjacent non-cancerous pancreatic parenchyma were analyzed for MVC using anti-CD31 antibody. In addition, the MVC of 15 hypervascular tumors (10 hepatocellular carcinomas: HCC and 5 islet cell pancreatic tumors: ICT), 30 other types of adenocarcinomas (10 gastric, 10 colon and 10 intraductal papillary mucinous tumors of the pancreas: IPMT), as well as that of non-cancerous areas, were also analyzed. The extent of hepatic and peritoneal spread in 24 pancreatic adenocarcinoma patients was classified and correlations with MVC were evaluated. The mean MVC of 24 pancreatic adenocarcinomas (31.6 +/- 11.1) was actually lower than that of HCCs (91.6) or ICTs (56.4). The diversity is temperate as compared with that of other adenocarcinomas, i.e., 42.9 in gastric carcinomas, 35.6 in colon carcinomas and 32.5 in IPMT. MVC in non-cancerous areas were significantly higher in the pancreas (112.8) than in the stomach (29.6) or colon (26.3). MVC ratios of the cancerous area to the non-cancerous area were significantly lower in the pancreas (0.2818 +/- 0.100) than in the stomach (1.569 +/- 0.526, p<0.001) or the colon (1.423 +/- 0.493, p<0.001). MVC were higher in diffuse hepatic metastasis patients (36.0) than in limited metastasis patients (25.7). In conclusion, MVC in pancreatic adenocarcinoma revealed vascular volume to actually be lower than that of hypervascular tumors. We believe, however, that this hypovascularity is due mainly to contrast with the hyper-vascular non-cancerous pancreas, since MVC in the cancerous area itself was at the same level as in other adenocarcinomas. In addition, we revealed MVC to be of value for predicting the extent of liver metastasis.
UI - 11836607
AU - Karanikas G; Ulrich-Pur H; Becherer A; Wiesner K; Dudczak R; Raderer M;
TI - Kletter K Uptake of indium-111-labeled human polyclonal immunoglobulin G in pancreatic cancer: in vivo and in vitro studies.
SO - Oncol Rep 2002 Mar-Apr;9(2):353-7
AD - Department of Nuclear Medicine, University of Vienna, A-1090 Vienna, Austria. firstname.lastname@example.org
Radiolabeled human non-specific polyclonal immunoglobulin G (HIG), is used for the diagnosis of inflammation/infection. Focal uptake of HIG in malignant lesions has also been reported. We investigated the diagnostic value of In-111-HIG in patients with known pancreatic cancer. Fourteen consecutive patients with histologically verified pancreatic cancer were included in this prospective study. Four of them had undergone potentially curative surgery for their primary cancer. Eight patients had liver metastases. Planar and SPECT images of the abdomen were performed after administration of In-111-HIG (74-92 MBq). Scintigraphic results were compared to conventional imaging by means of CT scanning. In addition, In-111-HIG uptake was investigated in a panel of four representative human pancreatic cancer cell lines. Primary pancreatic tumors were visualized by In-111-HIG in 6 out of 10 patients (sensitivity 60%), while 1 was false positive. In comparison, CT scanning was true positive in 9 out of 10 patients (sensitivity 90%), and no false positive. Visualization of liver lesions by means of In-111-HIG was possible in 6 out of 8 patients (sensitivity 75%), while 1 was false positive. In vitro studies revealed only minimal uptake of In-111-HIG into cells (about 3% of activity). Our data demonstrate that In-111-HIG is able to visualize pancreatic primary cancers as well as liver metastases. However, the minimal uptake into tumor cells, as shown in vitro, suggests non-specific tumor related inflammatory reactions, increased vascular permeability, release of indium from In-111-DTPA-labeled antibody and local retention to be responsible for visualization of the tumor site.
UI - 11870331
AU - Queneau PE; Sauve G; Koch S; Thibault P; Cleau D; Heyd B; Mantion G;
TI - Carayon P The impact on clinical practice of endoscopic ultrasonography used for the diagnosis and staging of pancreatic adenocarcinoma.
SO - JOP 2001 May;2(3):98-104
AD - Gastroenterology Unit and Digestive and Vascular Surgery Unit, University Hospital of Besancon, Besancon Cedex, France. email@example.com
CONTEXT: Endoscopic ultrasonography is considered a highly accurate procedure for diagnosing small pancreatic tumors and assessing their locoregional extension. OBJECTIVE: To evaluate the impact of endoscopic ultrasonography on the management of pancreatic adenocarcinoma in clinical practice. PATIENTS: Sixty-four consecutive patients (mean age 70.5 plus/minus 11.9 years) hospitalized for staging or diagnosis of 1999). SETTING: Group 1 consisted of 52 patients with pancreatic adenocarcinoma which was discovered using computerized tomography scanning and/or ultrasound. Endoscopic ultrasonography was utilized for staging purposes only in patients who were considered to be operable and the tumor to be resectable based on computerized tomography scanning criteria. Group 2 consisted of 12 patients who were diagnosed as having a pancreatic adenocarcinoma using endoscopic ultrasonography whereas computerized tomography scanning and ultrasound was negative. MAIN OUTCOME MEASURES: The impact of endoscopic ultrasonography was analyzed on the basis of the number of patients requiring endoscopic ultrasonography as a staging procedure (Group 1) and by evaluating the performance of endoscopic ultrasonography in determining resectability (Groups 1 and 2) based on the surgical and anatomopathological results. RESULTS: Endoscopic ultrasonography was performed in 20 out of 64 patients (31.3%): 8/52 in Group 1 (15.4%) and all 12 patients of Group 2. Endoscopic ultrasonography correctly assessed an absolute contraindication to resection in 11 cases. Resection was confirmed in 8 of the 9 cases selected by endoscopic ultrasonography. The positive predictive value, negative predictive value and overall accuracy of endoscopic ultrasonography for determining resection were 89%, 100%, and 95%, respectively. CONCLUSIONS: The impact of endoscopic ultrasonography seems especially relevant for the detection of pancreatic tumors after negative computerized tomography scanning, and for the prevention of unnecessary laparotomies as complementary staging after ultrasonography and computerized tomography scanning.
UI - 11959716
AU - Oshikawa O; Tanaka S; Ioka T; Nakaizumi A; Hamada Y; Mitani T
TI - Dynamic sonography of pancreatic tumors: comparison with dynamic CT.
SO - AJR Am J Roentgenol 2002 May;178(5):1133-7
AD - Division of Digestive Organs, Department of Cancer Survey, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3, Nakamichi, Higashinari, Osaka, 537-8511, Japan.
OBJECTIVE: The aim of this study was to examine the usefulness of dynamic sonography in the characterization of pancreatic tumors. MATERIALS AND METHODS: IV contrast-enhanced pancreatic sonography (dynamic sonography) with Levovist was performed in 43 patients with pancreatic mass lesions (32 with pancreatic adenocarcinomas, four with inflammatory pancreatic masses, three with islet cell tumors, two with serous cystadenomas, one with a solid and cystic tumor, and one with metastatic pancreatic cancer). We calculated a contrast index using a time-intensity curve: contrast index equals elevation of intensity in the tumor divided by elevation of intensity in the pancreatic parenchyma. We classified the tumors into three groups according to the contrast index: a slightly enhanced group (contrast index < 0.5), a moderately enhanced group (contrast index = 0.5-1.5), and a well-enhanced group (contrast index > 1.5), and we compared these results with those from dynamic CT. RESULTS: The contrast indexes of 32 adenocarcinomas, four inflammatory pancreatic masses, three islet cell tumors, two serous cystadenomas, one solid and cystic tumor, and one metastatic tumor were, respectively, 0.12 +/- 0.095 (mean +/- SD), 0.54 +/- 0.420, 1.74 +/- 0.555, 1.09 +/- 1.380, 1.67, and 2.07. Thirty-five tumors, including all 32 adenocarcinomas, were classified in the slightly enhanced group, three were classified in the moderately enhanced group, and five were classified in the well-enhanced group. In 93% (40/43) of tumors, the grade of enhancement on dynamic sonography was closely correlated with the grade of enhancement on dynamic CT. CONCLUSION: Dynamic sonography can assist in the characterization of pancreatic tumors.
UI - 11993688
AU - Wick MR; Graeme-Cook FM
TI - Pancreatic neuroendocrine neoplasms: a current summary of diagnostic, prognostic, and differential diagnostic information.
SO - Am J Clin Pathol 2001 Jun;115 Suppl():S28-45
AD - Department of Pathology, University of Virginia Health System, Charlottesville 22908-0214, USA.
Pancreatic endocrine tumors (PETs) continue to be challenging diagnostic and prognostic lesions in surgical pathology and clinical medicine. These neoplasms can be graded into 1 of 3 tiers, based on histologic characteristics in likeness to epithelial neuroendocrine tumors in other anatomic sites. However, grade 1 tumors are by far the most common and are the most difficult to prognosticate. The most helpful features by which to gauge the behavior of such lesions include size (3 cm or larger); mitotic activity (2 or more mitoses per 10 high-power [x400] microscopic fields); marked nuclear atypia, especially with atypical mitoticfigures; predominant tumor synthesis of gastrin, vasoactive intestinal polypeptide, somatostatin, glucagon, calcitonin, or adrenocorticotropic hormone; complete nonfunctionality of the tumor at an immunohistochemical level; or invasion of blood vessels, nerves, or adjacent organs by the neoplasm. Differential diagnosis of PETs includes lesions such as solid-pseudopapillary neoplasms, acinar carcinomas, metastatic neuroendocrine tumors, and plasmacytomas.
UI - 11753234
AU - Camera L; Bresciani M; Soscia E; Percopo V; Mainenti PP; Salvatore M
TI - [Morphological imaging of gastroenteropancreatic neuroendocrine tumours]
SO - Minerva Endocrinol 2001 Sep;26(3):123-8
AD - Consiglio Nazionale delle Ricerche, Dipartimento di Scienze Bio-morfologiche, Universita degli Studi Federico II, Naples, Italy.
Biologically active neuroendocrine tumours produce early symptoms and are often difficult to diagnose owing to their small dimensions (<1 cm), whereas biologically inactive forms are often coarse and sometimes found by chance. As well as identifying the lesion, locoregional staging is also particularly important for therapeutic planning. Morphological imaging plays an important role in the identification of gastroenteropancreatic neuroendocrine tumours, providing an anatomic substrate for receptorial imaging which usually precede it in the diagnostic work-up, whereas it plays a primary role in the locoregional staging of these neoplasms for which surgery is the first and essential therapeutic approach. In the case of endocrine tumours of the pancreas alone, the most accurate method of diagnosis is currently echo-endoscopy using high-frequency probes. Two-phase spiral CT and dynamic MR have proved equally effective means of identifying endocrine tumours of the pancreas with slightly higher sensitivity for MR, both playing a role in the locoregional staging of biologically active and inactive tumours. Traditional radiology also plays a role in the identification of intestinal carcinoids.
UI - 11995268
AU - Magee CJ; Shekouh A; Ghaneh P; Neoptolemos JP
TI - Update on pancreatic cancer.
SO - Hosp Med 2002 Apr;63(4):200-6
AD - University of Liverpool, Department of Surgery, Royal Liverpool, University Hospital, Liverpool L69 3GA.
Pancreatic cancer is one of the commonest causes of cancer death worldwide. Patients with pancreatic cancer benefit from resectional surgery (improved quality of life) and adjuvant treatment (enhanced survival). This review covers advances in the understanding of the development of pancreatic cancer, state-of-the-art clinical management and, finally, novel treatment and screening techniques.
UI - 11942011
AU - Alberti A; Dattola P; Littori F; Dattola A; Maccarone P; Basile M
TI - [Intraoperative ultrasonography in the staging of pancreatic head neoplasms]
SO - Chir Ital 2002 Jan-Feb;54(1):59-64
AD - Istituto di Chirurgia Generale, 1a Clinica Chirurgica Generale e Terapia Chirurgica, Via Consolare Valeria, Gazzi, 98100 Messina.
Tumours of the head of the pancreas constitute the fourth most common cause of cancer deaths. These tumours are characterised by low survival rates (5% at 5 years) and low surgical resectability rates (20-25%). Liver metastases, lymph-node and vascular involvement, and peritoneal metastases are, in our opinion, exclusion criteria for curative surgical resection. The aim of the study was to evaluate the impact of intraoperative ultrasonography on the staging of such tumours. Over the period from 1990 to 2000 we introduced intraoperative ultrasonography in the staging of pancreatic cancer. We evaluated 51 patients who at preoperative staging had been regarded as candidates for surgical therapy consisting in a pancreaticoduodenectomy. All patients had been staged by preoperative abdominal ultrasound, ERCP, CT and MRI. Intraoperative ultrasound and colour-Doppler imaging (from 1997 on) revealed involvement of (i) the liver, (ii) the splenomesenteric vessels and (iii) the portal vein. Intraoperative ultrasonography yielded a diagnosis of occult liver metastases in 10 cases and signs of vascular involvement (absence of cleavage, partial and total thrombosis) in 12. One false-negative was registered. Intraoperative ultrasonography in our experience showed 98% sensitivity and specificity in the detection of vascular and lymph-node involvement. Its sensitivity in the detection of liver metastases was 100%. Intraoperative ultrasound is a procedure with a very high sensitivity in the operative staging of cancer of the head of the pancreas.
UI - 11953884
AU - Rohloff J; Zinke J; Schoppmeyer K; Tannapfel A; Witzigmann H; Mossner J;
TI - Wittekind C; Caca K Heparanase expression is a prognostic indicator for postoperative survival in pancreatic adenocarcinoma.
SO - Br J Cancer 2002 Apr 22;86(8):1270-5
AD - Department of Medicine II, Leipzig University, Philipp-Rosenthal-Str. 27, 04103 Leipzig, Germany.
Pancreatic ductal adenocarcinoma has a median survival of less than 6 months from diagnosis. This is due to the difficulty in early diagnosis, the aggressive biological behaviour of the tumour and a lack of effective therapies for advanced disease. Mammalian heparanase is a heparan-sulphate proteoglycan cleaving enzyme. It helps to degrade the extracellular matrix and basement membranes and is involved in angiogenesis. Degradation of extracellular matrix and basement membranes as well as angiogenesis are key conditions for tumour cell spreading. Therefore, we have analysed the expression of heparanase in human pancreatic cancer tissue and cell lines. Heparanase is expressed in cell lines derived from primary tumours as well as from metastatic sites. By immunohistochemical analysis, it is preferentially expressed at the invading edge of a tumour at both metastatic and primary tumour sites. There is a trend towards heparanase expression in metastasising tumours as compared to locally growing tumours. Postoperative survival correlates inversely with heparanase expression of the tumour reflected by a median survival of 34 and 17 month for heparanase negative and positive tumours, respectively. Our results suggest, that heparanase promotes cancer cell invasion in pancreatic carcinoma and could be used as a prognostic indicator for postoperative survival of patients. Copyright 2002 Cancer Research UK
UI - 11978580
AU - Stolzenberg-Solomon RZ; Pietinen P; Taylor PR; Virtamo J; Albanes D
TI - Prospective study of diet and pancreatic cancer in male smokers.
SO - Am J Epidemiol 2002 May 1;155(9):783-92
AD - Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892-7232, USA. firstname.lastname@example.org
There have been few prospective studies relating diet to pancreatic cancer, with most having fewer than 100 cases and only one examining dietary nutrients. The authors prospectively examined dietary factors hypothesized to be associated with exocrine pancreatic cancer in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study cohort in Finland. Of the 27,111 male smokers aged 50-69 years with complete dietary information, as ascertained from a self-administered dietary history questionnaire given at baseline (1985-1988), 163 developed hazards models were used to estimate smoking- and age-adjusted hazard ratios and 95% confidence intervals. Energy-adjusted butter consumption and saturated fat intake were positively associated with pancreatic cancer (highest quintile vs. lowest: hazard ratio (HR) = 1.40, 95% confidence interval (CI): 0.87, 2.25 (p trend = 0.04), and HR = 1.60, 95% CI: 0.96, 2.64 (p trend = 0.02), respectively). Energy intake and energy-adjusted carbohydrate intake were inversely associated with the disease (highest quintile vs. lowest: HR = 0.62, 95% CI: 0.36, 1.07 (p trend = 0.05), and HR = 0.62, 95% CI: 0.37, 1.03 (p trend = 0.02), respectively). These results support the hypothesis that a high intake of saturated fat may increase the risk of pancreatic cancer in smokers, while greater intakes of energy and carbohydrate may reduce the risk.
UI - 11978581
AU - Potter JD
TI - Pancreas cancer--we know about smoking, but do we know anything else?
SO - Am J Epidemiol 2002 May 1;155(9):793-5; discussion 796-7
AD - Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA. email@example.com
UI - 12004989
AU - Baron TH; Fleischer DE
TI - Past, present, and future of endoscopic retrograde cholangiopancreatography: perspectives on the National Institutes of Health consensus conference.
SO - Mayo Clin Proc 2002 May;77(5):407-12
UI - 11839686
AU - Hindle KS; Kirkpatrick K; Mokbel K
TI - Correspondence re: Seki et al., Diagnosis of pancreatic adenocarcinoma by detection of human telomerase reverse transcriptase messenger RNA in pancreatic juice with sample qualification. Clin. Cancer Res., 7: 1976-1981, 2001.
SO - Clin Cancer Res 2002 Feb;8(2):628-9
UI - 11920735
AU - Pizzi S; D'Adda T; Azzoni C; Rindi G; Grigolato P; Pasquali C; Corleto
TI - VD; Delle Fave G; Bordi C Malignancy-associated allelic losses on the X-chromosome in foregut but not in midgut endocrine tumours.
SO - J Pathol 2002 Apr;196(4):401-7
AD - Department of Pathology and Laboratory Medicine, Section of Pathological Anatomy, University of Parma, Parma, Italy.
Information on genetic changes involved in the progression of gastroenteropancreatic (GEP) endocrine tumours is scanty. On the other hand, the identification of molecular markers of malignancy could be crucial for the prognostic evaluation of these neoplasms, which is hardly predictable on the basis of conventional histological criteria. An association of X-chromosome deletions with malignancy has already been found in gastric endocrine tumours. To investigate this further, a comparative loss of heterozygosity (LOH) analysis was performed on 17 pancreatic endocrine tumours (PETs) and 17 intestinal (ten ileal, six appendiceal, and one rectal) carcinoids from female patients. The relationship of X-chromosome LOH with the ploidy status of the neoplasms was also investigated. LOH was found in six of eight malignant PETs (60% of the informative markers), but was infrequent in the nine benign ones (4.5%). In contrast, although retention of heterozygosity was consistently observed in benign midgut tumours, LOH was infrequent in malignant carcinoids (15%). No correlation was found between LOH and the ploidy status. These results indicate an association between X-chromosome LOH and malignancy in foregut endocrine tumours. The lack of such an association in midgut carcinoids suggests that different molecular mechanisms are involved in the progression of these two categories of endocrine neoplasms, which are otherwise considered to be closely related. These findings emphasize the need for further molecular studies on GEP endocrine tumours, carefully subdivided according to their anatomical site of origin. Copyright 2002 John Wiley & Sons, Ltd.
UI - 11935313
AU - Maacke H; Hundertmark C; Miska S; Voss M; Kalthoff H; Sturzbecher HW
TI - Autoantibodies in sera of pancreatic cancer patients identify recombination factor Rad51 as a tumour-associated antigen.
SO - J Cancer Res Clin Oncol 2002 Apr;128(4):219-22
AD - Present address: Clinic for Internal Medicine II, Friedrich-Schiller University Jena, Erlanger Allee 101, 07743 Jena, Germany.
PURPOSE: The recombination factor Rad51 is highly expressed in human pancreatic adenocarcinoma. In this study we asked whether high-level expression of Rad51 antigen stimulates a B-cell response leading to Rad51-specific autoantibodies in human pancreatic cancer patients. METHODS: Sera of patients suffering from pancreatic cancer (57) as well as sera of healthy donors (86) were screened for Rad51 autoantibodies by Western-blot analysis. Rad51 over-expressing cell lines were used as antigen source. RESULTS: Four out of 57 (7%) sera tested were found positive for Rad51 autoantibodies of IgG subclass, while all 86 control sera were negative. CONCLUSION: This observation identifies Rad51 as a tumour-associated antigen in pancreatic adenocarcinoma. Since high-level expression of Rad51 is restricted to tumour cells, Rad51 is also a tumour-specific antigen. Further analyses should reveal whether Rad51 might also function as a tumour-specific transplantation antigen (TSTA) and whether it might serve as a target for new immunotherapeutical approaches.
UI - 11972546
AU - Yachida S; Fukushima N; Sakamoto M; Matsuno Y; Kosuge T; Hirohashi S
TI - Implications of peritoneal washing cytology in patients with potentially resectable pancreatic cancer.
SO - Br J Surg 2002 May;89(5):573-8
AD - Clinical Laboratory Division and Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital and Pathology Division, National Cancer Center Research Institute, Tokyo, Japan.
BACKGROUND: The aim of this study was to assess the implications of positive peritoneal washing cytology for management of patients with potentially resectable pancreatic cancer.METHODS: Cytological examination of peritoneal washings was performed in 134 patients who underwent surgical resection for pancreatic adenocarcinoma. The clinicopathological findings and the relationship between cytology results (including cytomorphology) and survival were investigated.RESULTS: One hundred and fourteen patients (85 per cent) had negative cytology results (group 1). Excluding one patient with atypical cells, positive cytology results were obtained in 19 patients (14 per cent): 16 patients without macroscopic peritoneal metastases (group 2) and three patients with minimal macroscopic peritoneal metastases (group 3). The patients in group 2 had significantly larger (P < 0.001) and more advanced (P = 0.022) tumours than those in group 1. However, there were no significant differences in postoperative cumulative survival rates between groups 1 and 2 (P = 0.347). Two patients in group 2 are long-term survivors (40 and 58 months). In cytomorphological analyses, the presence of clusters with ragged edges and isolated carcinoma cells can be considered to indicate a high risk of peritoneal recurrence.CONCLUSION: Positive cytology does not directly predict