Pancreatic Cancer: Current Options for Diagnosis, Staging and Therapeutic Management

Overview

Journal Gastrointest Tumors

Date 2015 Dec 18

PMID 26673950

Citations 11

Authors

Werner Hartwig

Markus W Buchler

Affiliations

Soon will be listed here.

Abstract

Background: Pancreatic cancer is characterized by frequently delayed diagnosis and aggressive tumor growth which hampers most of the current treatment modalities. This review aims to summarize the available evidence about the diagnostic and therapeutic aspects of resectable and non-resectable pancreatic cancer therapy.

Summary: Embedded in the concept of multimodal therapy, surgery plays the central role in the treatment of pancreatic cancer. With advantageous tumor characteristics and complete tumor resection as the most relevant positive prognostic factors, the detection of premalignant or early invasive lesions combined with safe and oncologic adequate surgery is the major therapeutic aim. Most pancreatic adenocarcinomas are locally advanced or metastatic when diagnosed and need to be treated by the combination of surgery and (radio)chemotherapy or by palliative chemotherapy.

Citing Articles

Intra-arterial Chemotherapy in Patients With Metastatic or Locally Aggressive Pancreatic Adenocarcinoma: A Scoping Review.

Basra M, Patel H, Biglione A Cureus. 2024; 16(5):e60696.

PMID: 38899244 PMC: 11186606. DOI: 10.7759/cureus.60696.

MicroRNAs as the critical regulators of epithelial mesenchymal transition in pancreatic tumor cells.

Tolue Ghasaban F, Ghanei M, Mahmoudian R, Taghehchian N, Abbaszadegan M, Moghbeli M Heliyon. 2024; 10(9):e30599.

PMID: 38726188 PMC: 11079401. DOI: 10.1016/j.heliyon.2024.e30599.

Registry-derived stage (RD-Stage) for capturing stage at diagnosis for pancreatic carcinoma in Australia.

Evans S, Ivanova K, Cossio D, Pilgrim C, Croagh D, Zalcberg J PLoS One. 2024; 19(1):e0294443.

PMID: 38166046 PMC: 10760927. DOI: 10.1371/journal.pone.0294443.

Predictive role of radiomics features extracted from preoperative cross-sectional imaging of pancreatic ductal adenocarcinoma in detecting lymph node metastasis: a systemic review and meta-analysis.

Mirza-Aghazadeh-Attari M, Madani S, Shahbazian H, Ansari G, Mohseni A, Borhani A Abdom Radiol (NY). 2023; 48(8):2570-2584.

PMID: 37202642 DOI: 10.1007/s00261-023-03940-y.

Prognostic Implications of Intratumoral and Peritumoral Infiltrating Lymphocytes in Pancreatic Ductal Adenocarcinoma.

Pyo J, Son B, Lee H, Oh I, Chung K Curr Oncol. 2021; 28(6):4367-4376.

PMID: 34898543 PMC: 8628731. DOI: 10.3390/curroncol28060371.

References

Madhoun M, Wani S, Rastogi A, Early D, Gaddam S, Tierney W . The diagnostic accuracy of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of solid pancreatic lesions: a meta-analysis. Endoscopy. 2013; 45(2):86-92. DOI: 10.1055/s-0032-1325992. View

Hartwig W, Schneider L, Diener M, Bergmann F, Buchler M, Werner J . Preoperative tissue diagnosis for tumours of the pancreas. Br J Surg. 2008; 96(1):5-20. DOI: 10.1002/bjs.6407. View

Matsubara J, Okusaka T, Morizane C, Ikeda M, Ueno H . Ultrasound-guided percutaneous pancreatic tumor biopsy in pancreatic cancer: a comparison with metastatic liver tumor biopsy, including sensitivity, specificity, and complications. J Gastroenterol. 2008; 43(3):225-32. DOI: 10.1007/s00535-007-2142-9. View

Konstantinidis I, Warshaw A, Allen J, Blaszkowsky L, Fernandez-Del Castillo C, Deshpande V . Pancreatic ductal adenocarcinoma: is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a "true" R0 resection?. Ann Surg. 2012; 257(4):731-6. DOI: 10.1097/SLA.0b013e318263da2f. View

Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K . Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007; 297(3):267-77. DOI: 10.1001/jama.297.3.267. View

Isaji S, Kawarada Y, Uemoto S . Classification of pancreatic cancer: comparison of Japanese and UICC classifications. Pancreas. 2004; 28(3):231-4. DOI: 10.1097/00006676-200404000-00003. View

Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y . FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011; 364(19):1817-25. DOI: 10.1056/NEJMoa1011923. View

Neoptolemos J, Dunn J, Stocken D, Almond J, Link K, Beger H . Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet. 2001; 358(9293):1576-85. DOI: 10.1016/s0140-6736(01)06651-x. View

Phillips V, Knopf D, Bernardino M . Percutaneous hepatic biopsy in suspected pancreatic carcinoma. J Comput Tomogr. 1984; 8(4):307-10. DOI: 10.1016/0149-936x(84)90080-8. View

10.

Mayo S, Nathan H, Cameron J, Olino K, Edil B, Herman J . Conditional survival in patients with pancreatic ductal adenocarcinoma resected with curative intent. Cancer. 2011; 118(10):2674-81. PMC: 3578343. DOI: 10.1002/cncr.26553. View

11.

Gillen S, Schuster T, Zum Buschenfelde C, Friess H, Kleeff J . Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010; 7(4):e1000267. PMC: 2857873. DOI: 10.1371/journal.pmed.1000267. View

12.

Nakamura R, Machado R, Amikura K, RUEBNER B, Frey C . Role of fine needle aspiration cytology and endoscopic biopsy in the preoperative assessment of pancreatic and peripancreatic malignancies. Int J Pancreatol. 1994; 16(1):17-21. DOI: 10.1007/BF02925605. View

13.

Berger A, Garcia Jr M, Hoffman J, Regine W, Abrams R, Safran H . Postresection CA 19-9 predicts overall survival in patients with pancreatic cancer treated with adjuvant chemoradiation: a prospective validation by RTOG 9704. J Clin Oncol. 2008; 26(36):5918-22. PMC: 2645109. DOI: 10.1200/JCO.2008.18.6288. View

14.

Callery M, Chang K, Fishman E, Talamonti M, Traverso L, Linehan D . Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol. 2009; 16(7):1727-33. DOI: 10.1245/s10434-009-0408-6. View

15.

Imamura M, Doi R, Imaizumi T, Funakoshi A, Wakasugi H, Sunamura M . A randomized multicenter trial comparing resection and radiochemotherapy for resectable locally invasive pancreatic cancer. Surgery. 2004; 136(5):1003-11. DOI: 10.1016/j.surg.2004.04.030. View

16.

Hartwig W, Strobel O, Hinz U, Fritz S, Hackert T, Roth C . CA19-9 in potentially resectable pancreatic cancer: perspective to adjust surgical and perioperative therapy. Ann Surg Oncol. 2012; 20(7):2188-96. DOI: 10.1245/s10434-012-2809-1. View

17.

Werner J, Combs S, Springfeld C, Hartwig W, Hackert T, Buchler M . Advanced-stage pancreatic cancer: therapy options. Nat Rev Clin Oncol. 2013; 10(6):323-33. DOI: 10.1038/nrclinonc.2013.66. View

18.

Tillou A, Schwartz M, JORDAN Jr P . Percutaneous needle biopsy of the pancreas: when should it be performed?. World J Surg. 1996; 20(3):283-6; discussion 287. DOI: 10.1007/s002689900045. View

19.

Chua T, Saxena A . Extended pancreaticoduodenectomy with vascular resection for pancreatic cancer: a systematic review. J Gastrointest Surg. 2010; 14(9):1442-52. DOI: 10.1007/s11605-009-1129-7. View

20.

Harewood G, Wiersema M . A cost analysis of endoscopic ultrasound in the evaluation of pancreatic head adenocarcinoma. Am J Gastroenterol. 2001; 96(9):2651-6. DOI: 10.1111/j.1572-0241.2001.04116.x. View