Pancreatic cancer: an endoscopic perspective

Majumder, Shounak; Chubineh, Saman; Birk, John

doi:10.1586/egh.11.93

Cited by 16 publications

(9 citation statements)

References 65 publications

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“…Since approximately 75% of all pancreatic carcinomas occur within the head or neck of the pancreas, it is difficult to diagnose pancreatic cancer in the early stage because of its anatomical location and atypical symptoms1,2. Most pancreatic cancers are diagnosed in the late stage after the patient presents with acute abdominal pain, lower back pain, or painless jaundice.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Iodine-125 Seed Implantation and Pancreaticoduodenectomy in the Treatment of Pancreatic Cancer

Li¹,

Ji²,

Zhang³

et al. 2014

Int. J. Med. Sci.

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Objective: This retrospective study compared the advantages and disadvantages of iodine-125 (125I) seed implantation and pancreaticoduodenectomy (PD) in the treatment of pancreatic cancer.Methods: Patients with diagnosed pancreatic cancer who were treated with 125125I seed implantation (30 patients) or PD (30 patients) in our hospital were evaluated for operative time, bleeding, liver function, time to first bowel movement and normal diet, survival, and medical costs.Results: Compared with patients who underwent PD, those given 125I seed implantation had significantly shorter operative time, less bleeding, higher albumin, shorter periods to bowel movement and normal diet, lower risk of complications, and lower medical costs (P < 0.001, each). The difference of bilirubin level, time to feeding, and median survival were not significant statistically between two treatment grouops.Conclusion: For pancreatic cancer patients for whom PD is not appropriate or who refuse PD, 125I seed implantation is a good option.

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Section: Discussionmentioning

confidence: 99%

“…The disease has an extremely poor prognosis because of the lack of early diagnostic symptoms and resistance to conventional chemo- and radiotherapies1,2. Pancreaticoduodenectomy (PD), also known as the Whipple procedure, is the standard curative surgical treatment for cancers of the head of the pancreas.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Iodine-125 Seed Implantation and Pancreaticoduodenectomy in the Treatment of Pancreatic Cancer

Li¹,

Ji²,

Zhang³

et al. 2014

Int. J. Med. Sci.

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“…Multiple imaging modalities, including transabdominal ultrasound, computed tomography (CT), magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography (EUS), are often used to diagnose and stage PanCa [5]. Because of the interference of intestinal gas, transabdominal ultrasound is used specifically to diagnose malignant pancreatic head tumors with middle accuracy [6].…”

Section: Introductionmentioning

confidence: 99%

“…With the widespread use of EUS and helical CT, endoscopic retrograde cholangiopancreatography is now rarely used for PanCa diagnosis and staging. EUS imaging of the pancreas has the inherent advantage of having a high-frequency transducer placed in close proximity to the tumor, thereby resulting in high-resolution images [5]. EUS offers the best sensitivity and specificity rates for lesions <2 cm; EUS, which is the most accurate method available for staging PanCa in the preoperative period, is predictive of surgical resectability [8,9,10].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Ultrasonography for Tumor Node Staging and Vascular Invasion in Pancreatic Cancer: A Meta-Analysis

He²,

et al. 2014

Dig Surg

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Background/Aims: The accurate staging of pancreatic cancer (PanCa) is crucial in the development of a stage-specific treatment plan for PanCa patients. We aimed to perform a meta-analysis of endoscopic ultrasonography (EUS) in the tumor node (TN) staging and evaluation of vascular invasion in PanCa. Methods: A meta-analysis of diagnostic accuracy parameters was performed to evaluate the EUS-based TN staging, and vascular invasion by PanCa was compared to the results of intraoperative staging or to the histopathology of resected specimens. Results: Twenty studies with 726 PanCa cases were identified from 281 articles. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were 0.72, 0.90, 6.27, 0.28, and 24.69, respectively, for T1-2 staging and 0.90, 0.72, 3.58, 0.16, and 24.69, respectively, for T3-4 staging. The overall sensitivity, specificity, PLR, NLR, and DOR were 0.62, 0.74, 2.54, 0.51, and 6.67, respectively, for N staging (positive vs. negative) and 0.87, 0.92, 7.16, 0.20, and 56.19, respectively, for vascular invasion. The area under the curve was 0.90, 0.90, 0.79, and 0.94 for T1-2 staging, T3-4 staging, N staging, and vascular invasion, respectively. Conclusions: EUS is a reliable and accurate diagnostic tool for the TN staging and evaluation of vascular invasion in PanCa. The nodal staging accuracy using EUS is less satisfactory. i 2014 S. Karger AG, Basel

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“…A recent review [4] of pancreatic cancer noted that on diagnosis 90% of tumors are already locally or systemically involved and therefore not operable. The average survival for those who are not operable is 4 months with the range of 3-11…”

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confidence: 99%

Complications from Stents and Lack of Conversations

Gallagher¹

2016

JGPLD

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was decompressed. Significant biliary duct dilatation, not present on his last CT scan, was noted and there were two irregular fluid collections containing small bubbles of air -probable liver abscesses -that had also developed. The liver metastases had all grown in size in the interim. Clostridium perfringens and Streptococcus anginosus grew in his blood and were susceptible to the antibiotics.The fentanyl infusion was titrated to effective pain relief but he remained delirious and died three days later.The oncologist called the wife several days after he became aware he was in the hospital and was surprised to find he had died. He notes that the wife was angry and told him that both the patient and she felt let down by the medical system and the physicians and nurses who had seen them for his illness. The physician noted "unfortunately clinical deterioration in such as this is all too common in the context of metastatic pancreatic cancer". This case is instructive for two reasons: the risk of serious sepsis in patients with stents and the bereavement reaction of the spouse.Clostridium perfringens is an anaerobic normal inhabitant of the bowel and genital tract. Septicemia from this bacteria usually occurs in patients who are immunocompromized (malignancy, diabetes etc) and have had a recent abdominal or pelvic procedure [1]. The mortality rate is extremely high. Streptococcus anginosus is also associated with abscesses in those who are immunocompromized.Therapy for the complications of pancreatic cancer has evolved tremendously over the last 20 years with the introduction of stenting by endoscopy. Complications such as the liver abscesses, are being reduced by the use of covered self expandable metal stents that have a lower risk of cholangitis and infection [2]. Stenting shows a shortened time to resumption of fluids and food, reduced hospital stay and costs when compared with surgery [3].A recent review [4] of pancreatic cancer noted that on diagnosis 90% of tumors are already locally or systemically involved and therefore not operable. The average survival for those who are not operable is 4 months with the range of 3-11 Case ReportA 59 year-old man had several months of epigastric distress and pain radiating to the back before presenting with obstructive jaundice. CT scan of the abdomen showed a 4cm mass in the pancreas. The biliary obstruction was located 4cm above the ampulla and resolved with the insertion of a Cotton Leung plastic stent. Lesions in the liver, seen on ultrasound, could not be confirmed as metastases on CT scan. Biopsy of the liver lesions by laparoscopy confirmed them as metastases so he was referred for chemotherapy.One month later he developed increasing epigastric pain and vomiting. CT scan showed duodenal obstruction secondary to local tumor growth. An expanding metal stent was inserted via endoscopy and the vomiting stopped the next day. X-ray confirmed good position of the duodenal stent and since he was tolerating fluids he was discharged home the next day.Fatigue, weakness and p...

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Pancreatic cancer: an endoscopic perspective

Cited by 16 publications

References 65 publications

Comparison of Iodine-125 Seed Implantation and Pancreaticoduodenectomy in the Treatment of Pancreatic Cancer

Comparison of Iodine-125 Seed Implantation and Pancreaticoduodenectomy in the Treatment of Pancreatic Cancer

Endoscopic Ultrasonography for Tumor Node Staging and Vascular Invasion in Pancreatic Cancer: A Meta-Analysis

Complications from Stents and Lack of Conversations

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