my personal edition > pancreatic cancer > news


  E-Mail this DGDispatch to a colleague

DGDispatch

Patients at Very High Risk of Inherited Pancreatic Cancer Aided by Intensive Surveillance: Presented at DDW

By Bruce Sylvester

SAN DIEGO -- May 26, 2008 -- Close surveillance of persons with familial high risk for pancreatic cancer using endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) can improve detection of curable pancreatic precancerous lesions, researchers reported here at Digestive Disease Week (DDW) 2008.

"EUS can help physicians detect pancreatic neoplasia in these vulnerable patients when performed in a specialised centre," said investigator Teresa A. Brentnall, MD, Associate Professor of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington.

This kind of attentive care can lead to the detection of curable pancreatic precancerous lesions, the researcher said during a media briefing on May 20.

According to Dr. Brentnall and coinvestigators, "At least 10% of pancreatic cancer is inherited. Because the disease is uniformly lethal, detection at the precancerous stage may save lives. The time course of pancreatic neoplastic progression is largely unknown in humans and the effectiveness of surveillance is just beginning to be explored."

The investigators enrolled 100 subjects from 73 familial pancreatic cancer kindreds and followed them for 10 years in a pancreatic surveillance program. They performed EUS at baseline and annually thereafter. ERCP was performed in subjects with distinctly abnormal EUS findings who had no cause for pancreatitis, such as heavy alcohol or biliary stones.

Subjects with an abnormal EUS and abnormal ERCP were given the option of having surgery to obtain pancreatic tissue for histological diagnosis.

Selected patients with strong family history and histological evidence of advanced pancreatic neoplasia were given the option of undergoing a pancreatectomy after in-depth diabetic education and risk counselling.

Two patients developed cancer (1 inoperable), and 20 patients developed advanced pancreatic neoplasia (12 carcinomas in situ/stage 3 pancreatic intraepithelial neoplasias [PanIN] and 8 low-grade dysplasias/stage 2 PanIN).

Fifty-two patients (52%) had abnormal EUS findings on initial examination; 3 of these patients stopped drinking alcohol and the EUS changes reverted to normal.

Ten of the 48 subjects with an initial normal EUS developed new abnormal EUS findings during surveillance. The average time to progression was 1.7 years (range, 1-5 years). Four of these subjects eventually developed abnormal ERCP findings and had surgery, 3 subjects had widespread carcinoma in situ, and 1 developed grade 2 PanIN.

The 2 subjects with cancer developed new masses after 1 and 4 years of surveillance.

Four patients developed other cancers while in the 10-year surveillance program (2 breast, 1 lung, 1 renal).

None of the patients with advanced pancreatic precancerous lesions who underwent pancreatectomy developed pancreatic cancer during an average follow-up of 7 years. One patient who failed to participate completely in postoperative follow-up died of hypoglycaemia.

The authors concluded, "A combination of EUS and ERCP can aid in the detection of pancreatic neoplasia when performed in a specialised centre and can lead to the detection of curable precancer. The endoscopic changes that newly developed in these surveillance patients suggest that the natural history of neoplasia advances quickly over a period of 1 to 5 years. Waiting for masses to form in the pancreas during endoscopic surveillance may yield inoperable disease."

[Presentation title: Surveillance and Natural History of High Risk Patients Who Inherit Pancreatic Cancer. Abstract 644]

E-Mail this DGDispatch to a colleague

To print, use this version