UMLS:C0027627 - FACTA Search

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Query: UMLS:C0027627 (metastases)
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Abdominal ultrasound is the primary imaging study for patients with suspected pancreatic carcinoma. Unless the tumor is large, this test might not be abnormal. The next appropriate test in the diagnostic work-up is the EUS. If this technique is not available, dual-phase spiral CT might be ordered instead. In cases which remain unclear or require palliative relief of biliary obstruction. It has been proposed that diagnosis and staging of a pancreatic carcinoma can be afforded by an all-in-one investigation using MRI, MRCP and MR-angiography. But at present, the superiority of MRI for diagnosing pancreatic cancer is insufficiently established. Conventional angiography does no longer play a role in the staging process. Fine-needle aspiration of focal pancreatic lesions is only recommended in patients who have unresectable lesions or who are more likely to have a focal inflammatory lesion in chronic pancreatitis. Laparoscopy is indicated if there is a high likelihood of unrecognized peritoneal or hepatic micrometastases in patients who are otherwise candidates for a surgical cure. Furthermore, laparoscopy should only be performed if the proof of metastases precludes further surgery or if palliative surgery is not necessary. Tumor markers and genetic markers might help to detect pancreatic cancer. However, the optimal screening method for the diagnosis of early and potentially curable pancreatic cancer is not in sight as yet.
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PMID:[Gastroenterology diagnosis of pancreatic carcinoma]. 1114 38

Pancreatic cancer has a poor prognosis, and the best chance for survival is to diagnose the tumour at an early stage. Abdominal ultrasound, computed tomography, magnetic resonance imaging and endoscopic retrograde cholangiopancreatography are the most commonly used radiological techniques for imaging the pancreas. The diagnostic evaluation should be tailored to the individual patient. Dual-phase helical computed tomography and magnetic resonance imaging have similar accuracies for detecting and staging pancreatic adenocarcinoma. Sonography results are highly dependent on the skill and persistence of the operator. No radiological examination is very sensitive at visualizing small metastases in the lymph nodes and peritoneum, or on the surface of the liver. Thus, it is difficult to establish with certainty whether a tumour is resectable. Another major challenge is to differentiate cancer from an inflammatory mass in chronic pancreatitis. Functional imaging (using positron emission tomography with fluorodeoxyglucose) may be helpful, especially if the images are fused with those of computed tomography or magnetic resonance imaging. The diagnostic accuracies, applications and limitations of the various modalities are discussed.
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PMID:Cancer of the pancreas: the best image for early detection--CT, MRI, PET or US? 1187 94

Endoscopic ultrasound (EUS) plays a vital role in management of upper gastrointestinal disorders, particularly cancer of the esophagus, pancreas, stomach, lung (via transesophageal mediastinal staging), and bile duct. Endoscopic ultrasound has also been valuable in detection of early chronic pancreatitis (CP). In cancer of the esophagus, the primary role of EUS is to determine whether disease is localized (T1-2, N0) and appropriate for surgery, locally advanced (T3-4, N1, M1a) (which may benefit from chemoradiation with or without surgery), or metastatic. Pancreatic and bile duct cancers are more complex given the controversy over portal vein resection. In centers that resect tumors invading the portal venous system, the role of EUS is limited to tissue confirmation or identification of metastases to the liver or distant lymph nodes. In centers that do not resect the portal vein invasion, EUS plays an important role in local staging. In lung cancer, EUS is emerging as an accurate, nonsurgical alternative to staging the mediastinum through EUS fine-needle aspiration. Endoscopic ultrasound has an important role in diagnosing CP because of its high degree of sensitivity. This has also led to controversy over whether EUS can overdiagnose CP. For these reasons, we recommend the use of a high threshold for EUS and that CP be diagnosed in conjunction with other standard tests (endoscopic retrograde cholangiopancreatography, pancreatic function tests).
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PMID:Endoscopic ultrasound and upper gastrointestinal disorders. 1254 91

Recent advances in technology and techniques have opened the gates widely to a wide range of applications of minimally invasive surgery in patients with inflammatory and neoplastic diseases of the pancreas. Laparoscopic cholecystectomy is the gold standard treatment for prevention of further attacks of acute biliary pancreatitis. Bile duct calculi detected at intraoperative cholangiography in patients with mild attacks of pancreatitis may be safely managed with laparoscopic bile duct exploration. Laparoscopic internal drainage of large, persistent and symptomatic pancreatic pseudocysts is safely applicable to most patients, achieves adequate drainage and facilitates debridement, and brings recognised benefits over open surgery and endoscopic approaches. Laparoscopic pancreatic necrosectomy for infected necrosis is feasible in some patients but the benefits of this approach in this high-risk group of patients remain to be shown. Staging laparoscopy and laparoscopic ultrasound avoids unnecessary laparotomy in approximately one-fifth of patients with pancreatic cancer, but their routine application in patients with ampullary and duodenal cancers is not warranted. The majority of patients with periampullary cancer have locally advanced or metastatic disease at presentation and their management is entirely palliative. Laparoscopic surgery therefore has its place in the relief of biliary and gastric outlet obstruction, and has its advantages over endoscopic biliary and duodenal stenting in patients with predicted better prognosis, though these advantages ought to be confirmed in randomised controlled trials. Thoracoscopic splanchnicectomy is beneficial in the short-to-medium term for the palliation of intractable opiate-dependent abdominal pain of locally advanced pancreatic cancer and that of chronic pancreatitis with demonstrable improvements in quality of life. Laparoscopic enucleation of neuroendocrine tumours of the pancreas, and distal or subtotal pancreatectomy with or without preservation of the splenic vessels and spleen for neuroendocrine and cystic tumours, and in some patients with chronic pancreatitis is feasible and safe. In experienced hands, this minimally invasive approach reduces postoperative hospital stay and expedites recovery. However, the incidence of pancreatic fistula following distal resection is not any less than that of open surgery. Although the previous limited experience with laparoscopic pancreaticoduodenectomy was discouraging, the recent experience with the hand-assisted approach is quite favourable and is likely to expand.
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PMID:Pancreatic surgery in the laparoscopic era. 1461 98

MUC4 is highly expressed in human pancreatic tumours and pancreatic tumour cell lines, but is minimally or not expressed in normal pancreas or chronic pancreatitis. Here, we investigated the aberrant regulation of MUC4 expression in vivo using clonal human pancreatic tumour cells (CD18/HPAF) grown either orthotopically in the pancreas (OT) or ectopically in subcutaneous tissue (SC) in the nude mice. Histological examination of the OT and SC tumours showed moderately differentiated and anaplastic morphology, respectively. The OT tumour cells showed metastases to distant lymph nodes and faster tumour growth (P<0.01) compared to the SC tumours. The MUC4 transcripts in OT tumours were very high compared to the undetectable levels in SC tumours. The SC tumour cells regained their ability to express MUC4 transcripts after in vitro culture. Immunohistochemical analysis using MUC4-specific polyclonal antiserum confirmed the results obtained by Northern blot analysis. Interestingly, the OT tumours showed expression of TGFbeta2 compared to no expression in SC, suggesting a possible link between MUC4 and TGFbeta2. The MUC4 expression, morphology, and metastasis of human pancreatic tumour cells are regulated by a local host microenvironment. TGFbeta2 may serve as an interim regulator of this function.
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PMID:MUC4 mucin expression in human pancreatic tumours is affected by organ environment: the possible role of TGFbeta2. 1476 Mar 81

The aim of this study was to assess the value of TPS and CA 19-9 in a long-term follow-up analysis of 11 patients with chronic pancreatitis (CP) and 15 patients with pancreatic cancer (PC). In all monitored patients with chronic pancreatitis the initial TPS level was below 200 U/L, whereas CA 19-9 was elevated in two of them. In one patient a dramatic increase in the TPS concentration (820 U/L) was measured at the last follow-up visit (after 8.6 months), which led to the detection of PC. In all patients with PC the preoperative TPS level exceeded 200 U/L, whereas CA 19-9 was elevated in only nine patients. After the Kausch-Whipple operation 11 patients showed no evidence of disease and in eight of these patients both TPS and CA 19-9 were within the reference range; however, in three patients liver metastases were detected after 8-24 months from the last tumor marker measurement. In four of the 15 patients both markers were elevated at the end of the follow-up period and distant metastases were clinically confirmed. Our results indicate that in patients with CP and PC undergoing long-term follow-up, TPS reflects the clinical status of patients more accurately than CA 19-9.
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PMID:TPS and CA 19-9 measurements in the follow-up of patients with pancreatic cancer and chronic pancreatitis. 1525 43

If there is a "science" of tumor-stromal interactions, there must be a set of biologic rules that are organ-site dependent. One way to explore this hypothesis would be to compare the patterns of gene expression of two biologically distinct neoplasms that arise within the same organ site. Using nonradioactive in situ hybridization, we evaluated the gene expression patterns of three genes previously shown to be robust markers of the juxtatumoral stroma within eight infiltrating ductal adenocarcinoma of the pancreas (ApoC1, ApoD and MMP11), and compared these patterns to those associated with seven infiltrating colloid and tubular carcinomas arising in association with intraductal papillary mucinous neoplasms (IPMNs), a histologically distinct form of primary carcinoma of the pancreas, two surgically resected samples of chronic pancreatitis and two surgically resected pancreatic cancer liver metastases. Robust juxtatumoral stromal expression was noted for all three markers within all eight conventional infiltrating ductal adenocarcinoma tissues, but not in samples of chronic pancreatitis. Among the carcinomas arising within an IPMN, expression for all three markers was also noted for five of seven infiltrating carcinomas analyzed. However, when labeling for these three markers was analyzed with respect to infiltrative growth pattern, positive labeling was only seen in areas of tubular (ductal-type) growth and not in areas of colloid carcinoma. This observation was further supported by two infiltrating carcinomas arising in an IPMN that showed both tubular and colloid growth patterns within the same neoplasm indicating the host stromal response observed may relate to infiltrative growth pattern rather than the biology of the primary tumor type. Moreover, these robust patterns within conventional infiltrating ductal adenocarcinomas were not retained within matched metastases to the liver, indicating the importance of the tumor microenvironment in the host stromal response. Juxtatumoral stroma was found to be composed of a least two cell types, tumor-infiltrating macrophages and fibroblasts, highlighting the complexity of tumor-stromal interactions within an infiltrating carcinoma. Since the juxtatumoral gene expression response is the strongest indication of direct communication between stroma and cancer cells, we provide evidence of a stereotypical response to infiltrative growth that might predominate in tumor-stromal interactions independent of cancer type, a finding with clinical implications for therapeutic modalities that target this response in human tumors.
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PMID:Stromal responses to carcinomas of the pancreas: juxtatumoral gene expression conforms to the infiltrating pattern and not the biologic subtype. 1587 73

MR imaging is a valuable tool in the assessment of the full spectrum of pancreatic diseases. MR imaging techniques are sensitive for the evaluation of pancreatic disorders in the following settings: (1) TI-weighted fat-suppressed and dynamic gadolinium-enhanced SGE imaging for the detection of chronic pancreatitis, ductal adeno-carcinoma, and islet-cell tumors; (2) T2-weighted fat-suppressed imaging and T2-weighted breath-hold imaging for the detection of islet-cell tumors;and (3) precontrast breath-hold SGE imaging for the detection of acute pancreatitis. Relatively specific morphologic and signal intensity features permit characterization of acute pancreatitis,chronic pancreatitis, ductal adenocarcinoma, insulinoma, gastrinoma, glucagonoma, microcystic cystadenoma, macrocystic cystadenoma, and solid and papillary epithelial neoplasm. MR imaging is effective as a problem-solving modality because it distinguishes chronic pancreatitis from normal pancreas and chronic pancreatitis with focal enlargement from pancreatic cancer in the majority of cases.MR imaging studies should be considered in the following settings: (1) in patients with elevated serum creatinine, allergy to iodine contrast, or other contraindications for iodine contrast administration; (2) in patients with prior CT imaging who have focal enlargement of the pancreas with no definable mass; (3) in patients in whom clinical history is worrisome for malignancy and in whom findings on CT imaging are equivocal or difficult to interpret; and (4) in situations requiring distinction between chronic pancreatitis with focal enlargement and pancreatic cancer. Patients with biochemical evidence of islet-cell tumors should be examined by MR imaging as the first-line imaging modality because of the high sensitivity of MR imaging for detecting the presence of islet-cell tumors and determining the presence of metastatic disease.
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PMID:MR imaging of the pancreas. 1593 14

Serological screening approaches have allowed for the identification of a large number of potentially relevant tumor antigens in cancer patients. Within this group, cancer testis antigens represent promising targets for cancer immunotherapy, since they are widely expressed in a variety of human cancer entities. In pancreatic cancer, however, there are only few data available about the expression pattern and serological response to cancer testis antigens and other serological-defined tumor antigens. Therefore, we investigated the IgG antibody response against 11 cancer testis antigens (SCP-1, GAGE, LAGE-1a,-1b, CT-7, NY-ESO-1, SSX-1-5) recombinantly expressed on yeast surface (RAYS) in patients with pancreatic cancer (n = 96), chronic pancreatitis (n = 18) and healthy donors (n = 48). We found in 14% of all patients antibody responses to SCP-1, but not to other cancer testis antigens (GAGE, LAGE-1a,-1b, CT-7, NY-ESO-1, SSX-1-5). Antibody response correlated with the expression of SCP-1 in the primary tumor of the respective patient as shown by RT-PCR, immunohistochemistry and Western blot. In contrast, no serological response to cancer testis antigens was observed in healthy donors. The humoral immune response against SCP-1 was associated with the size of tumor, but not with other clinico-pathological parameters such as histology, stage, presence of lymph node metastases, grading, age, gender or gemcitabine treatment. In conclusion, antibody response to cancer testis antigen SCP-1 is found in a proportion of pancreatic carcinoma patients. These results indicate that identification of additional tumor antigens by serological screening of tumor cDNA expression libraries by RAYS is a promising goal in pancreatic cancer.
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PMID:Serological immune response to cancer testis antigens in patients with pancreatic cancer. 1643 32

Maspin, a member of the serpin family of serine protease inhibitors, has been shown to limit invasion and metastases in breast and prostate carcinomas. Maspin gene expression is up-regulated in pancreatic cancer, but not in normal pancreatic tissue. Maspin expression has been documented using immunohistochemical studies in pancreatic adenocarcinoma and high-grade intraductal dysplasia. We studied pancreatic ductal adenocarcinomas and chronic pancreatitis utilizing tissue microarray technology to determine the utility of maspin in differentiating these lesions. Immunohistochemistry was performed on tissue microarrays made from 72 cases of pancreatic ductal adenocarcinoma and 24 cases of chronic pancreatitis. Carcinomas were graded as well, moderately, or poorly differentiated using the WHO criteria. The primary antibody used was monoclonal antimaspin antibody (clone G167-70, 1:800, PharMingen, San Diego, CA). Nuclear and/or cytoplasmic staining for maspin was qualitatively scored from 1 + to 3 + based on intensity. Cases were considered positive if one or more cores demonstrated staining. Cases of chronic pancreatitis showed focal, weak (1 + to 2 +) staining within occasional benign ductal epithelial cells in 29% of cases (7/24). Diffuse and intense (3 +) staining was present in ducts with squamous metaplasia (3 cases). The majority of ducts showed no staining. Ductal adenocarcinomas showed diffuse staining in 91% (66/72) of cases with generally more intense staining than cases of chronic pancreatitis. Maspin may be helpful in differentiating ductal adenocarcinoma from chronic pancreatitis, once squamous metaplasia is ruled out.
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PMID:Maspin is useful in the distinction of pancreatic adenocarcinoma from chronic pancreatitis: a tissue microarray based study. 1753 9

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