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Abramson Cancer CenterNCI CANCERLIT® Search: Diagnosis-Histopathology-Pathogenesis of Pancreatic Cancer - January 2002
National Cancer Institute®
Last Modified: January 1, 2002
Table of Contents
1
UI - 10769297
AU - Ojajarvi IA; Partanen TJ; Ahlbom A; Boffetta P; Hakulinen T; Jourenkova
TI -
N; Kauppinen TP; Kogevinas M; Porta M; Vainio HU; Weiderpass E;
Wesseling CH
Occupational exposures and pancreatic cancer: a meta-analysis.
SO - Occup Environ Med 2000 May;57(5):316-24
AD - Department of Epidemiology and Biostatistics, Finnish Institute of
Occupational Health, Topeliuksenk 41A, 00250 Helsinki, Finland.
aoja@occuphealth.fi
OBJECTIVES: Consolidation of epidemiological data on pancreatic cancer
and worksite exposures. METHODS: Publications during 1969-98 were
surveyed. Studies without verified exposures were excluded.
Meta-analyses were conducted on data from 92 studies covering 161
populations, with results for 23 agents or groups of agents. With a
standard format, five epidemiologists extracted risk estimates and
variables of the structure and quality of each study. The extracted data
were centrally checked. Random meta-models were applied. RESULTS: Based
on 20 populations, exposure to chlorinated hydrocarbon (CHC) solvents
and related compounds was associated with a meta-risk ratio (MRR) of 1.4
(95% confidence interval (95% CI) 1.0 to 1.8). Nickel and nickel
compounds were considered in four populations (1.9; 1.2 to 3.2).
Excesses were found also for chromium and chromium compounds (1.4; 0.9
to 2.3), polycyclic aromatic hydrocarbons (PAHs) (1.5; 0.9 to 2.5),
organochlorine insecticides (1.5; 0.6 to 3.7), silica dust (1.4; 0.9 to
2.0), and aliphatic and alicyclic hydrocarbon solvents (1.3; 0.8 to
2.8). Evidence on pancreatic carcinogenicity was weak or non-positive
for the following agents: acrylonitrile (1.1; 0.0 to 6.2); arsenic (1.0;
0.6 to 1.5); asbestos (1.1; 0.9 to 1.5); diesel engine exhaust (1.0; 0.9
to 1.3); electromagnetic fields (1.1; 0.8 to 1.4); formaldehyde (0. 8;
0.5 to 1.0); flour dust (1.1; 0.3 to 3.2); cadmium and cadmium compounds
(0.7; 0.4 to 1.4); gasoline (1.0; 0.8 to 1.2); herbicides (1.0; 0.8 to
1.3); iron and iron compounds (1.3; 0.7 to 2.5); lead and lead compounds
(1.1; 0.8 to 1.5); man-made vitreous fibres (1.0; 0.6 to 1.6); oil mist
(0.9; 0.8 to 1.0); and wood dust (1.1; 0.9 to 2.5). The occupational
aetiological fraction of pancreatic cancer was estimated at 12%. In a
subpopulation exposed to CHC solvents and related compounds, it was 29%;
to chromium and chromium compounds, 23%; to nickel and nickel compounds,
47%; to insecticides, 33%; and to PAHs, 33%. CONCLUSION: Occupational
exposures may increase risk of pancreatic cancer. High quality studies
are called for on interactions between occupational, environmental, and
lifestyle factors as well as interactions between genes and the
environment.
2
UI - 10882255
AU - Curry CA; Eng J; Horton KM; Urban B; Siegelman S; Kuszyk BS; Fishman EK
TI -
CT of primary cystic pancreatic neoplasms: can CT be used for patient
triage and treatment?
SO - AJR Am J Roentgenol 2000 Jul;175(1):99-103
AD - Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD
21287, USA.
OBJECTIVE: The purpose of this study was to determine whether CT can be
used to distinguish serous cystadenomas from mucinous cystadenomas or
cystadenocarcinomas of the pancreas and play an enhanced role in patient
triage and treatment. MATERIALS AND METHODS: A blinded retrospective
analysis of CT scans from 50 patients with pathologically proven primary
cystic pancreatic neoplasms was performed independently by three
radiologists. Using classic CT criteria as reported in the literature,
each tumor was categorized as definitely serous, mucinous, or
indeterminate. Tumor location, size, presence of calcification, and size
of largest cyst were recorded. Data for each reviewer were analyzed
independently. Consensus data were then subjected to multivariate
logistic regression analysis. RESULTS: The ability of our reviewers to
diagnose serous neoplasms ranged from 23% to 41%. Eight mucinous
neoplasms were mistaken for serous tumors by two of the three reviewers.
When consensus between at least two of the three reviewers was used for
diagnosis, 27% of serous neoplasms were correctly diagnosed and all of
the mucinous tumors were correctly identified as uncertain or mucinous,
yielding the same clinical end point. For multivariate logistic
regression analysis, a cyst smaller than 2 cm had a statistically
significant association (p = 0.005) with serous tumors, and the presence
of peripheral tumoral calcification had a statistically significant
association (p = 0.01) with mucinous tumors. CONCLUSION: There is
significant variability in the CT appearance of serous and mucinous
neoplasms of the pancreas, making CT an insensitive tool for
differentiating these tumors. All tumors with peripheral calcifications
were identified as mucinous neoplasms.
3
UI - 10963196
AU - Adamek HE; Albert J; Breer H; Weitz M; Schilling D; Riemann JF
TI -
Pancreatic cancer detection with magnetic resonance
cholangiopancreatography and endoscopic retrograde
cholangiopancreatography: a prospective controlled study.
SO - Lancet 2000 Jul 15;356(9225):190-3
AD - Department of Medicine, Klinikum Ludwigshafen, Academic Hospital of the
University of Mainz, Germany.
BACKGROUND: Magnetic resonance cholangiopancreatography (MRCP) is a
non-invasive and increasingly used procedure in cases involving biliary
and pancreatic diseases. However, the accuracy of MRCP in differential
diagnosis between pancreatic cancer and chronic pancreatitis has never
been documented in a large prospective controlled study. METHODS: 124
patients were recruited for the study, selected from 141 consecutive
patients with an average age of 55 years (range 19-80) who presented to
our department between February, 1996, and January, 1998, with a strong
clinical suspicion of pancreatic cancer. MRCP images were interpreted by
a radiologist and a gastroenterologist who were unaware of the clinical
diagnosis of patients. The exact diagnosis was based upon histological
evidence from biopsy examination (surgical and fine needle biopsy) or a
follow-up of at least 12 months. FINDINGS: Of the 124 patients, 37 (30%)
had pancreatic carcinoma; 17 (14%) had other neoplastic pancreatic
diseases; 57 (46%) had chronic pancreatitis; 13 (10%) pancreatic ducts
were clear. The sensitivity of MRCP with respect to diagnosing
pancreatic cancer was 84% and its specificity 97%. The corresponding
values for endoscopic retrograde cholangiopancreatography (ERCP) were
70% and 94%, respectively. INTERPRETATION: MRCP is as sensitive as ERCP
when detecting pancreatic carcinomas. Furthermore, it is feasible to
presume that the use of MRCP may prevent inappropriate explorations of
the pancreatic and common bileducts in cases of suspected pancreatic
carcinomas, where interventional endoscopic therapy (ie, palliative
common-bileduct drainage) is unlikely.
4
UI - 11216453
AU - Seilkop SK
TI -
Occupational exposures and pancreatic cancer: a meta-analysis.
SO - Occup Environ Med 2001 Jan;58(1):63-4
5
UI - 11248065
AU - Su GH; Bansal R; Murphy KM; Montgomery E; Yeo CJ; Hruban RH; Kern SE
TI -
ACVR1B (ALK4, activin receptor type 1B) gene mutations in pancreatic
carcinoma.
SO - Proc Natl Acad Sci U S A 2001 Mar 13;98(6):3254-7
AD - Department of Oncology, Pathology, and Surgery, The Johns Hopkins
Medical Institutions, Baltimore, MD 21231, USA.
DPC4 is known to mediate signals initiated by type beta transforming
growth factor (TGFbeta) as well as by other TGFbeta superfamily ligands
such as activin and BMP (bone morphogenic proteins), but mutational
surveys of such non-TGFbeta receptors have been negative to date. Here
we describe the gene structure and novel somatic mutations of the
activin type I receptor, ACVR1B, in pancreatic cancer. ACVR1B has not
been described previously as a mutated tumor-suppressor gene.
6
UI - 11496502
AU - Barsegian AA; Fedenko VV
TI -
[Laparoscopic surgery in tumor obstruction of the biliary tract]
SO - Vestn Khir Im I I Grek 2001;160(2):89-94
The article gives a detailed description of the technique of
laparoscopic biliodigestive anastomoses in patients with advanced tumors
of hepatopancreatoduodenal zone. The authors have an experience with 18
operations. They performed 14 cholecystoenteroanastomoses including 9
total laparoscopic operations and 5 operations through a combined
approach--laparoscopy in combination with minilaparotomy. The authors
believe that laparoscopic surgery is feasible and safe for treatment of
these patients. The combined approach has financial advantages giving
the possibility to save the disposable stapling devices.
7
UI - 11444473
AU - Monstein HJ; Ohlsson B; Axelson J
TI -
Differential expression of gastrin, cholecystokinin-A and
cholecystokinin-B receptor mRNA in human pancreatic cancer cell lines.
SO - Scand J Gastroenterol 2001 Jul;36(7):738-43
AD - Molecular Biology Laboratory, University Hospital, Linkoping, Sweden.
BACKGROUND: It has been assumed that gastrin stimulates the growth of
pancreatic cancer in an autocrine way through co-expression of gastrin
and the cholecystokinin-B receptor (CCK-BR). However, pancreatic cancer
cell lines established directly from patients have revealed a great
heterogeneity in cell proliferation when exposed to CCK, gastrin and
their receptor antagonists. The aim of this study was therefore to
examine co-expression of CCK-A and CCK-B receptor (CCK-AR and CCK-BR),
and gastrin mRNA as well as the secretion of CCK and gastrin peptides in
these cell lines. METHODS: Fourteen cell lines were established from
primary pancreatic cancers or their metastases. Total RNA was isolated
from the cell lines and reverse-transcribed into single-stranded cDNA. A
PCR technique based on Taq polymerase-antibody interaction and CCK-AR,
CCK-BR and gastrin-specific primers, followed by Southern blot analysis,
were the methods used. The incubation mediums were analysed for the
presence of secreted CCK/proCCK and gastrin/progastrin peptides by
specific radioimmunoassays (RIA). RESULTS: By means of nested
Reverse-Transcribed Polymerase Chain Reaction (nested RT-PCR), combined
with Southem blot analysis of the PCR amplified products, CCK-AR and
gastrin mRNA co-expression was detected in cell lines LPC-6p and
LPC-10m, whereas CCK-BR and gastrin mRNA could be detected in cell lines
LPC-8p and LPC-12m. A low level of secreted CCK peptides was detected in
cell line LPC-6p, which also expressed CCK-AR mRNA. In no other cases
were CCK or gastrin peptides detected in the cell culture mediums.
CONCLUSION: The lack of CCK-BR and gastrin mRNA co-expression, and not
detectable levels of secreted CCK and gastrin in culture media, does not
lend support to the hypothesis that concomitant gene-expression of CCK
receptors and gastrin or CCK are essential to maintaining pancreatic
cancer cell proliferation.
8
UI - 11464498
AU - Napolitano L; Francomano F; Gargano E; Francione T; Angelucci D;
TI -
Napolitano AM
[Our experience regarding biologically inactive gastroenteropancreatic
neuroendocrine tumors]
SO - Ann Ital Chir 2001 Jan-Feb;72(1):61-4; discussion 65
AD - Dipartimento di Scienze Chirurgiche Universita di Chieti.
The Authors present 9 cases of gastro-enteropancreatic neuro-endocrine
biologically inactive tumors. In 5 cases the tumor site was
appendicular. In 4 patients an appendectomy was performed, in one
patient a right hemicolectomy and the patients after a period of 3-9
years are well and disease free. In a patient with a gastric carcinoid
and a single hepatic metastasis a total gastrectomy with an hepatic
metastasectomy were performed but the patient died 16 months thereafter.
In a case localized to the right colon with a single hepatic metastasis
a right hemicolectomy was performed with a metastasectomy but the
patient died after 12 months. In a case localized to an ileal loop a
segmental resection was performed followed by a medical therapy with
octreotide and the patient is well and disease free after 3 years. In a
case localized to the pancreas with widespread lymphatic metastasis it
was performed a simple biliary diversion (coledocho-duodenostomy)
followed by medical therapy with octreotide. Surprisingly after 4 years
the patient is alive and a TC control shows a decrease of the pancreatic
tumor and of the lympho glandular tumefactions.
9
UI - 11471608
AU - Procacci C; Carbognin G; Accordini S; Biasiutti C; Bicego E; Romano L;
TI -
Guarise A; Minniti S; Pagnotta N; Falconi M
Nonfunctioning endocrine tumors of the pancreas: possibilities of spiral
CT characterization.
SO - Eur Radiol 2001;11(7):1175-83
AD - Department of Radiology, University of Verona Medical School,
Policlinico G.B. Rossi, Italy. procacci@borgoroma.univr.it
The aim of this study was to assess the ability of spiral CT to
adequately characterize the nonfunctioning endocrine tumors (NFETs) of
the pancreas, distinguishing this lesion from the other pancreatic
tumors. The spiral CT examinations of 21 cases of histologically proven
NFETs, along with those of 29 cases of other pancreatic tumors and
tumor-like lesions, were retrospectively reviewed in a blinded fashion
by two radiologists, in order to correctly classify the lesions,
highlighting the typical signs reported in the literature. Discordant
cases were further analyzed in the presence of a third radiologist. The
final diagnosis was acquired by means of a majority or overall
consensus. The histopathologic examination was considered the gold
standard. The sensitivity, specificity, and positive and negative
predictive values of CT were calculated. After the consensus evaluation,
the correct diagnosis was reached in 72% of cases, with 10% of
nonspecific diagnoses of solid pancreatic tumor and 18% of wrong
diagnoses. The sensitivity and specificity of spiral CT in identifying
NFETs were 66.6 and 82.7%, respectively. The positive and negative
predictive values were 73.7 and 77.4%, respectively. In up to 70% of
cases the NFET demonstrates a typical aspect of a mass hyperdense in the
arterial contrastographic phase eventually associated with hyperdense
hepatic metastases in more than half of the patients. This finding does
allow the diagnosis of NFET but without certainty indeed, since other
tumors can show a similar densitometric behavior and among them
particularly the ductal adenocarcinoma. On the other hand, both the
solid, hypovascularized NFETs, and the cystic form, cannot be
differentiated from the other solid and cystic tumors of the pancreas.
10
UI - 11461889
AU - Friedman AC; Clifford P; Wynn G
TI -
CT of primary cystic pancreatic neoplasms: nihilism may be unwarranted.
SO - AJR Am J Roentgenol 2001 Aug;177(2):469-70
11
UI - 11486805
AU - Roebuck DJ; Yuen MK; Wong YC; Shing MK; Lee CW; Li CK
TI -
Imaging features of pancreatoblastoma.
SO - Pediatr Radiol 2001 Jul;31(7):501-6
AD - Department of Diagnostic Radiology and Organ Imaging, Chinese University
of Hong Kong.
BACKGROUND: Pancreatoblastoma is a rare tumour of childhood. Reports of
the imaging appearances are limited. OBJECTIVE: To define the imaging
features of pancreatoblastoma by analysis of four previously unreported
cases and review of the literature. MATERIALS AND METHODS: Findings at
CT (n = 4), US (n = 3) and MRI (n = 2) were retrospectively reviewed in
four patients with pancreatoblastoma. A Medline search was performed to
identify relevant literature. RESULTS: Pancreatoblastoma arises most
frequently in the body and/or tail, or involves the entire pancreas.
Ultrasonography, CT and MRI show variable imaging features, but should
in most cases permit preoperative distinction of pancreatoblastoma from
other tumours that occur in this region in infancy and childhood.
Detection of metastases in the liver, lymph nodes and peritoneal cavity
is not significantly better with any one of these three modalities.
CONCLUSION: Preoperative imaging with US, CT and/or MRI will usually
suggest a correct diagnosis of pancreatoblastoma. Contrary to previous
reports, the tumour arises in the pancreatic head in a minority of
cases.
12
UI - 11490822
AU - Yoshizawa K; Nagai H; Kurihara K; Sata N; Kawai T; Saito K
TI -
Long-term survival after surgical resection for pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):1153-6
AD - Department of Surgery, Jichi Medical School, 3311-1 Yakushiji,
Minami-Kawachi, Tochigi 329-0498, Japan. k-yoshi@jichi.ac.jp
BACKGROUND/AIMS: Pancreatic cancer remains one of the most formidable
tumors defying early detection and effective treatment. Long-term
survivors, however, do exist after resection. We investigated the
clinicopathologic features of patients with pancreatic cancer who
survived more than 5 years to draw out some suggestions concerning the
indication of surgical treatment. METHODOLOGY: We studied the
clinicopathologic features of 13 patients with pancreatic cancer who
survived more than 5 years after resection. We reviewed their clinical
records to investigate preoperative symptoms, serum tumor markers,
operative findings, postoperative adjuvant therapy, and modes of
recurrence and survival periods. Information on the location, size,
histology and spread of the primary tumors were mainly obtained from
pathology reports. RESULTS: Histologic types of the long survivors
included ductal adenocarcinoma of common type in 4 patients, mucinous
noncystic adenocarcinoma in 2, intraductal papillary-mucinous carcinoma
(invasive) in 4, undifferentiated carcinoma in 1, endocrine tumor (islet
cell carcinoma) in 1 and acinar cell carcinoma in 1. All 4 cases of
ductal adenocarcinoma of the common type showed a moderate invasion
either to the retroperitoneum, the portal vein or the duodenum. Two
patients with mucinous noncystic carcinoma attained a long survival
despite extensive invasion of the pancreatic stroma, although one died
of peritoneal carcinomatosis. Two of 4 patients with intraductal
papillary-mucinous cancer (invasive) died of peritoneal dissemination 6
and 11 years after resection, respectively. Three patients with cancer
of other special histologic types, i.e., undifferentiated,
well-differentiated endocrine carcinoma and acinar cell carcinoma,
showed invasion of the portal vein and splenic artery, involvement of
the retroperitoneum and a metastatic tumor in the liver, respectively.
CONCLUSIONS: Whereas special histologic types including ductal variants
tended to predispose to long-term survival, ductal adenocarcinoma of the
common type had some chance of long survival even with invasion of the
surrounding tissues.
13
UI - 11490824
AU - Knoll MR; Rudnitzki D; Sturm J; Manegold BC; Post S; Jaeger TM
TI -
Correlation of postoperative survival and angiogenic growth factors in
pancreatic carcinoma.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):1162-5
AD - Department of Endoscopic Surgery, University Hospital Mannheim
University of Heidelberg, Theodor-Kutzer-Ufer, D-68135 Mannheim,
Germany.
BACKGROUND/AIMS: VEGF (vascular endothelial growth factor) and EGF
(epidermal growth factor) are promoters of angiogenesis. It was the aim
of this study to investigate a possible coexpression of both growth
factors in tumor samples of pancreatic cancer patients in relation to
survival after resection of the tumor. METHODOLOGY: We investigated the
expression of VEGF165 and EGF in tumor specimen from 19 patients that
underwent pancreaticoduodenectomy. Growth factor expression was
determined using immunohistochemical methods. RESULTS: Coexpression of
VEGF165 and EGF was observed in tumor samples of 9 (47%) patients.
VEGF165 and EGF expression in the same tumor correlates significantly (P
< 0.05, Fisher-test). UICC stage III pancreatic carcinoma patients with
VEGF165 negative tumor cells had a significantly better outcome after
surgery compared to UICC stage III patients with VEGF165-positive tumor
cells (median survival time 19 months vs. 9 months respectively; P <
0.05, Wilcoxon-test). CONCLUSIONS: Antiangiogenic therapy after surgery
for pancreatic cancer may be beneficial, especially for UICC III
patients.
14
UI - 11490839
AU - Nakao A
TI -
Recent advances in diagnosis and treatment of pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):914-5
15
UI - 11490840
AU - Hirooka Y; Goto H; Ito A; Hashimoto S; Hirai T; Niwa K; Takeda K;
TI -
Hayakawa T
Recent advances in US diagnosis of pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):916-22
AD - Second Department of Internal Medicine, Nagoya University School of
Medicine, Nagoya, Japan. hirooka@med.nagoya-u.ac.jp
Recent years have seen dramatic developments in extracorporeal
ultrasonography: Color, including-power Doppler ultrasonography,
ultrasonography angiography, harmonic imaging (tissue harmonic imaging
and contrast harmonic imaging) and 3-dimensional ultrasonography
(including virtual endoscopy). In this report, we describe the present
situation and the prospective outlook for these new diagnostic
modalities mainly on the basis of our own experiences.
16
UI - 11490841
AU - Ishiguchi T; Ota T; Naganawa S; Fukatsu H; Itoh S; Ishigaki T
TI -
CT and MR imaging of pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):923-7
AD - Department of Radiology, Aichi Medical University, 21 Nagakute-cho,
Aichi-gun, Aichi-ken, 480-1195, Japan. ishiguti@aichi-med-u.ac.jp
Recent improvements in imaging techniques have made it possible to
improve the diagnostic accuracy for detection, staging, and indicating
surgical resectability of pancreatic cancer. The latest advance in the
computed tomography technique, is the introduction of subsecond
multislice helical scanning that improves z-axis resolution in the
reformatted images and three-dimensional rendering with a large volume
data. Magnetic resonance imaging provides versatile information
including magnetic resonance cholangiopancreatography that allows
noninvasive delineation of the pancreatic and biliary duct systems. The
presence of pancreatic cancer may best be evaluated by dynamic computed
tomography or dynamic magnetic resonance imaging with administration of
intravenous contrast material. Both computed tomography and magnetic
resonance imaging are valuable for the preoperative assessment of local
invasion and vascular involvement. Multislice helical computed
tomography is currently considered as the best single modality for the
diagnosis of pancreatic cancer as it provides excellent image quality.
When advanced magnetic resonance imaging equipment is used as a primary
modality, in the future, it may have a possibility to replace other
imaging modalities.
17
UI - 11490842
AU - Itoh A; Goto H; Hirooka Y; Hashimoto S; Hirai T; Niwa K; Takeda K;
TI -
Hayakawa T
Endoscopic diagnosis of pancreatic cancer using intraductal
ultrasonography.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):928-32
AD - Second Department of Internal Medicine, Nagoya University School of
Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan.
BACKGROUND/AIMS: At present developed modalities are not sufficient for
detecting early stage pancreatic cancer. We previously reported the
clinical usefulness of intraductal ultrasonography in various
pancreatobiliary diseases. In the present study we assessed the
usefulness of intraductal ultrasonography in diagnosing pancreatic
cancer. METHODOLOGY: Thirty-one patients with pancreatic cancer were
examined by intraductal ultrasonography. We approached the main
pancreatic duct (pancreatic duct-intraductal ultrasonography) in 24 of
31 patients and the bile duct (bile duct-intraductal ultrasonography) in
20 patients with pancreatic cancer. We compared the diagnostic ability
of pancreatic duct-intraductal ultrasonography with that of
extracorporeal ultrasonography, computed tomography, endoscopic
ultrasonography or endoscopic retrograde pancreatography. We examined
the usefulness of bile duct-intraductal ultrasonography in diagnosing
tumor invasion to the bile duct. RESULTS: Pancreatic duct-intraductal
ultrasonography was able to demonstrate a tumor in 22 of 24 patients.
Extracorporeal ultrasonography, computed tomography, endoscopic
ultrasonography or endoscopic retrograde pancreatography detected tumors
in 26, 27, 29, 29 of 31 patients, respectively. In two patients, only
intraductal ultrasonography could demonstrate a tumor, which was not
detected by any other modalities. We examined bile duct invasion of the
tumor according to our grading system. The overall accuracy rate was
90%. No complications were noted in any patients throughout the study
period. CONCLUSIONS: Intraductal ultrasonography is useful to diagnose
pancreatic cancer, and it is suggested that it should be actively
performed after endoscopic retrograde pancreatography.
18
UI - 11490843
AU - Inoue S; Tezel E; Nakao A
TI -
Molecular diagnosis of pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):933-8
AD - Department of Surgery II, Nagoya University School of Medicine, 65
Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Pancreatic ductal adenocarcinoma is a result of accumulated genetic
alterations, including oncogenes such as K-ras, tumor-suppressor genes
such as p53, p16 and DPC4 and genome-maintenance genes such as BRCA2,
microsatellite instability and telomerase. Recent findings which
characterize the molecular genetic profile of the pancreatic cancer have
reshaped the nomenclature describing histological progression in
pancreatic ductal tumorigenesis. K-ras mutations frequently occur early,
whereas changes in the expression and genetic integrity of the p16 gene
appear in intermediate lesions, and the inactivation of the p53, DPC4
genes and activation of telomerase occur late in the neoplastic
progression. So far K-ras and telomerase activity have been used as
molecular markers for the diagnosis of pancreatic carcinoma, whereas p53
and p16 may be a prognostic indicator of pancreatic cancer. Additional
tumor-suppressor genes and the related signaling pathway such as ALK-5
are likely to be defined. In addition to the human genome project, these
new advances hopefully will accelerate the development of diagnostic and
screening techniques for this grave condition.
19
UI - 11490844
AU - Ichihara T; Nomoto S; Takeda S; Nagura H; Sakamoto J; Kondo K; Horisawa
TI -
M; Nakao A
Clinical usefulness of the immunostaining of the tumor markers in
pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):939-43
AD - Department of Surgery, Nagoya National Hospital, 4-1-1 San-no-maru,
Naka-ku, Nagoya, Aichi 460-0001, Japan.
The effect of the rapid immunostaining of gastrointestinal
cancer-associated antigens, CA19-9, CEA, DUPAN2, and CA50 was discussed
for intraoperative pathological diagnosis of pancreatic cancer. The
method can be completed in only 13 minutes with microwave irradiation to
accelerate the incubation of the primary antibody. Only 3 seconds of
irradiation at 500 W for fresh-frozen sections produced specific antigen
staining of greater intensity than that obtained with longer incubation
by the conventional method. Preservation of the tissue structure was
satisfactory with minimal nonspecific background staining enabling us to
diagnose the intrapancreatic spread of cancer. This method was also
applied to intraoperative peritoneal washing cytology. As with frozen
section biopsy, the sensitivity of intraoperative cytology is greater
than by the conventional staining method, which is able to achieve more
precise staging of pancreatic cancers. Our rapid immunoperoxidase
staining method on the cryostat section of pancreatic biopsy specimens
and on cytology samples provides important information to determine an
appropriate operative approach for pancreatic cancer.
20
UI - 11490845
AU - Kaneko T; Inoue S; Sugimoto H; Takeda S; Harada A; Nakao A
TI -
Intraoperative diagnosis of pancreatic cancer extension using IVUS.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):944-8
AD - Department of Surgery II, Nagoya University School of Medicine, 65
Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
BACKGROUND/AIMS: Pancreatic cancer easily invades retroperitoneal
tissue, especially the portal vein and extrapancreatic nerve plexus. We
evaluated the diagnostic accuracy of intraportal endovascular
ultrasonography in portal vein and extrapancreatic nerve plexus
invasion. METHODOLOGY: Intraportal endovascular ultrasonography was
performed in 78 cases of pancreatic cancer (head 67, body 8, total 3).
Intraportal endovascular ultrasonography was performed intraoperatively
from the superior mesenteric vein with an 8-French, 20-MHz intravascular
ultrasound catheter. Three-dimensional intraportal endovascular
ultrasonography was constructed by volume rendering. RESULTS:
Intraportal endovascular ultrasonography visualized the portal vein as
an echogenic band with a thickness of 0.5 mm to 1.0 mm. The diagnostic
criterion of portal vein invasion was obliteration of this echogenic
band. Intraportal endovascular ultrasonography visualized segment II of
the extrapancreatic nerve plexus as the high-echoic area around the
inferior pancreaticoduodenal artery. The diagnostic criterion of
extrapancreatic nerve plexus invasion was low-echoic infiltration around
the inferior pancreaticoduodenal artery. The sensitivity, specificity,
and overall accuracy of intraportal endovascular ultrasonography for
diagnosis of portal vein invasion was, respectively, 97.4%, 92.5%, and
94.9%. The values for diagnosis of extrapancreatic nerve plexus
invasion, respectively, were 94.4%, 97.1%, and 96.2%. Three-dimensional
intraportal endovascular ultrasonography depicted the invasion area as a
defect of the portal vein wall. CONCLUSIONS: Intraportal endovascular
ultrasonography detected subtle portal invasion and provided accurate
portal invasion area which was useful for portal vein an reconstruction.
Intraportal endovascular ultrasonography could also diagnose the
extrapancreatic nerve plexus invasion of segment II.
21
UI - 11490849
AU - Yamao K; Ohashi K; Nakamura T; Suzuki T; Watanabe Y; Shimizu Y; Nakamura
TI -
Y; Ozden I
Evaluation of various imaging methods in the differential diagnosis of
intraductal papillary-mucinous tumor (IPMT) of the pancreas.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):962-6
AD - Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1
Kanokoden, Chikusa-ku, Nagoya, Japan 464. kyamao@acc.pref.aichi.jp
BACKGROUND/AIMS: IPMT (intraductal papillary-mucinous tumor) of the
pancreas has unique clinicopathological characteristics. The lesions
which show characteristic clinical features of IPMT exhibit a wide
spectrum of histological types ranging from atypical hyperplasia to
invasive cancer. Therefore, surgical treatment cannot be recommended for
all patients with IPMT. It is necessary to assess the malignant
potential of IPMT in individual patients in order to select an
appropriate approach. The aim of this study was to evaluate the
effectiveness of endoscopic ultrasonography and intraductal
ultrasonography as compared with ultrasonography and computed tomography
for this purpose. METHODOLOGY: Ultrasonography, computed tomography,
endoscopic ultrasonography and intraductal ultrasonography were
performed in 49 cases of IPMT (atypical hyperplasia 7, adenoma 23,
noninvasive 7 and invasive adenocarcinoma 12). On the basis of the
histopathological analysis of another 28 cases of resected IPMT
specimens, criteria for differential diagnosis by imaging modalities
were defined as follows: Nonneoplastic lesion (atypical hyperplasia): no
wall thickening or nodule; noninvasive IPMT (adenoma and intraductal
carcinoma): a nodule or wall thickening is present; and invasive IPMT
with pancreatic parenchymal invasion: a mass with a heterogenous pattern
or interruption of the pancreatic duct wall by the mass. RESULTS: The
diagnostic accuracy rate for differentiating nonneoplastic lesion
noninvasive IPMT, and invasive IPMT was 33% by ultrasonography, 38% by
computed tomography, 77% by endoscopic ultrasonography, and 67% by
intraductal ultrasonography. Sensitivity, specificity and accuracy rates
for differentiating neoplastic and nonneoplastic IPMT by ultrasonography
was 33%, 100%, 42%, by computed tomography 36%, 100%, 44%, by endoscopic
ultrasonography 90%, 71%, 88%, by intraductal ultrasonography 94%, 29%,
84%, respectively. Sensitivity, specificity and accuracy rates for
differentiating invasive and noninvasive IPMT by ultrasonography was
25%, 100%, 80%, by computed tomography 33%, 100%, 83%, by endoscopic
ultrasonography 55%, 97%, 88%, by intraductal ultrasonography 56%, 91%,
84%, respectively. Diagnostic accuracy for invasive IPMT except
minimally invasive cases by endoscopic ultrasonography and intraductal
ultrasonography was 80%, based on the results of the examination which
demonstrated a higher grade lesion. CONCLUSIONS: With these criteria,
ultrasonography and computed tomography showed high specificity, but low
sensitivity for the differential diagnosis of neoplastic/nonneoplastic
and invasive/noninvasive IPMT. However, endoscopic ultrasonography and
intraductal ultrasonography had high sensitivity and diagnostic accuracy
for the differential diagnosis of neoplastic/nonneoplastic lesions.
Combination of endoscopic ultrasonography and intraductal
ultrasonography showed a high accuracy rate in the diagnosis of invasive
IPMT. Thus endoscopic ultrasonography and intraductal ultrasonography
contributed significantly to the choice of the treatment for IPMT.
22
UI - 11490851
AU - Nagasaka T; Nakashima N
TI -
Problems in histological diagnosis of intraductal papillary-mucinous
tumor (IPMT).
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):972-6
AD - Division of Pathology, Clinical Laboratory Nagoya University Hospital,
Tsurumai-Cho 65, Showa-ku, Nagoya 466-8560, Japan.
nagat@tsuru.med.nagoya-u.ac.jp
IPMTs (intraductal papillary-mucinous tumors) of the pancreas have been
recognized as a distinct clinical entity. WHO used this term in most
recent classification (1996). The present report reviews the WHO
classification and recent descriptions of IPMT. Problems regarding the
histological diagnosis and differential diagnosis are also discussed. In
the WHO classification, IPMTs are classified into three categories:
intraductal papillary-mucinous adenoma, intraductal papillary-mucinous
tumor with moderate dysplasia and intraductal papillary-mucinous
carcinoma. The classification is based on the tissue morphology, such as
degree of dysplasia and pattern of proliferation. Some
immunohistochemical and molecular markers have been reported for
differential diagnosis and estimating the prognosis of IPMT. MUC1,
Dpc-4, p53 and Ki-67. In making a differential diagnosis, mucinous
cystic tumors are the most problematic. Communication with the
pancreatic ducts, the presence of ovarian type stroma and capsular
formation are key histological factors for a differential diagnosis
between IPMTs and mucinous cystic tumors. The prognosis of IPMTs is
favorable in general. However, once massive invasion has occurred, the
prognosis is very poor, as in cases of ductal carcinoma. For further
studies of IPMT, pathologists and clinicians involved in the diagnosis
and treatment of IPMTs need to understand the concept of IPMTs and use
the WHO classification.
23
UI - 11504292
AU - Mullan MH; Gauger PG; Thompson NW
TI -
Endocrine tumours of the pancreas: review and recent advances.
SO - ANZ J Surg 2001 Aug;71(8):475-82
AD - Department of Surgery, Division of Endocrine Surgery, University of
Michigan Hospital, Ann Arbor 48109-0331, USA.
Pancreatic endocrine tumours (PET) are rare but nonetheless important to
recognize and treat in a timely fashion. Significant morbidity occurs
due to excess secretion of hormones, with all of the PET having some
degree of malignant potential. Surgeons must plan directed operative
strategies to deal with these tumours and be prepared to undertake
aggressive palliative debulking resections if indicated. Somatostatin
receptor scintigraphy and endoscopic ultrasound have been particularly
helpful in both localizing and staging patients with PET. Other
important advances in management include the use of long-acting
somatostatin analogues to inhibit hormonal secretion and tumour growth.
The possibility of multiple endocrine neoplasia type 1 (MEN-1) should be
considered in any patient with a PET. The present article will review
the various classes of PET, describe MEN-1 in relation to PET and
examine advances in imaging and localization. The role of surgery for
PET is also discussed in the present review.
24
UI - 11520088
AU - van Geenen RC; van Gulik TM; Offerhaus GJ; de Wit LT; Busch OR; Obertop
TI -
H; Gouma DJ
Survival after pancreaticoduodenectomy for periampullary adenocarcinoma:
an update.
SO - Eur J Surg Oncol 2001 Sep;27(6):549-57
AD - Department of Surgery, Academic Medical Center, Amsterdam, The
Netherlands.
AIM: Survival after pancreaticoduodenectomy for periampullary tumours is
limited. Over the last decade peri-operative management has improved and
morbidity and mortality decreased. The aim of the study was to analyse
recent survival data after pancreaticoduodenectomy and to determine
1998, 204 patients with a ductal adenocarcinoma in the pancreatic head
(108), distal bile duct (32), and ampulla (64) who underwent standard
pancreaticoduodenectomy, were analysed with regard to histology and
tumour status. Survival was calculated by using the Kaplan-Meier method.
Risk factors were identified in a univariate and multivariate analysis.
RESULTS: Median survival after resection for carcinoma of the pancreatic
head, distal bile duct, and ampulla were 16, 25 and 24 months,
respectively (P=0.008). In the univariate analysis vein resection, blood
transfusion of more than four packed red cells, the presence of tumour
positive resection margins, lymph-node metastases and poor tumour
differentiation significantly decreased survival. In the multivariate
analysis positive resection margins, lymph-node metastases, and poor
tumour differentiation independently influenced survival. CONCLUSIONS:
Resection margins, lymph-node status and tumour differentiation are
independent prognostic factors. Survival after standard
pancreaticoduodenectomy for periampullary tumours has not improved.
Copyright 2001 Harcourt Publishers Limited.
25
UI - 11550286
AU - Moore PS; Missiaglia E; Antonello D; Zamo A; Zamboni G; Corleto V;
TI -
Falconi M; Scarpa A
Role of disease-causing genes in sporadic pancreatic endocrine tumors:
MEN1 and VHL.
SO - Genes Chromosomes Cancer 2001 Oct;32(2):177-81
AD - Department of Pathology, Universita di Verona, Strada le Grazie 8,
I-37134 Verona, Italy.
Pancreatic endocrine tumors (PETs) occur in association with multiple
endocrine neoplasia type 1 (MEN1) and von Hippel-Lindau (VHL) syndromes
caused by germline alterations in MEN1 and VHL, respectively. It is thus
expected that these genes will also be altered in a proportion of
sporadic PETs. Indeed, MEN1 is altered in about 25% of nonfamilial PETs,
although no mutations have been found in VHL. For all clinical subtypes,
the frequency of allelic loss on chromosome arm 11q mirrors observed
mutational frequencies, with the exception of nonfunctional tumors
(NF-PETs), in which mutations have been reported in only 8% of cases. As
allelic loss on 11q is the most frequent event found in these neoplasms,
this low frequency is somewhat puzzling, particularly in light of the
fact that most MEN1-associated PETs are nonfunctioning. To clarify the
role of these genes in sporadic PETs, we analyzed 31 sporadic NF-PETs,
nine insulinomas, and one VIPoma for alterations in MEN1 and VHL. As
somatic mutations were observed in eight (26%) of the NF tumors and in
one insulinoma, it would therefore appear unlikely that an additional
tumor suppressor gene related to sporadic PET pathogenesis is located on
11q. One insulinoma also had a somatic mutation in VHL, and thus this
gene may also be altered in these neoplasms, albeit in a small
proportion of cases. Copyright 2001 Wiley-Liss, Inc.
26
UI - 11558060
AU - Rickes
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