BACKGROUND/AIMS: According to Tsuchiya's collective review on small pancreatic cancer measuring 2 cm or less in diameter (5), more than half of them had obstructive jaundice and the 5-year survival rate was as low as 30%. Thus, a more aggressive diagnostic approach is needed to detect a smaller and more curable cancer of the pancreas. METHODOLOGY: Thus, we collected 36 reported cases of "minute" pancreatic cancer measuring 1 cm or less in diameter, from Japanese medical literature, to analyze the relationships between the diagnostic processes and long-term results. RESULTS: Excluding 3 patients with obstructive jaundice, the other 33 patients did not show any specific initial symptoms. However, 28 (78%) out of 36 patients showed an elevation in serum pancreatic enzyme levels and/or glucose intolerance. Among the 35 patients who had received ultrasonography (US) and/or computed tomography (CT), 20 (57%) patients showed duct dilation alone, whereas only 9 patients (26%) showed tumor mass. Among 35 patients who received an endoscopic retrograde pancreatography (ERP), all patients showed positive findings such as obstruction/stenosis, filling defect or duct dilation. All 36 patients underwent pancreatectomy and the 5-year survival rate was 57%. However, the 5-year survival rate was 34% in the 13 patients with jaundice and/or tumor mass depicted in US/CT, while it was 69% for the 22 patients without these two findings (p < 0.05). CONCLUSIONS: These data lead us to conclude that an elevation of serum pancreatic enzyme levels, glucose intolerance, and duct dilation alone depicted by US/CT should not be overlooked. ERP should be more widely applied to such patients, instead of persisting in delineating the tumor mass by US/CT or follow-up by tumor marker.
BACKGROUND/AIMS: According to Tsuchiya's collective review on small pancreatic cancer measuring 2 cm or less in diameter (5), more than half of them had obstructive jaundice and the 5-year survival rate was as low as 30%. Thus, a more aggressive diagnostic approach is needed to detect a smaller and more curable cancer of the pancreas. METHODOLOGY: Thus, we collected 36 reported cases of "minute" pancreatic cancer measuring 1 cm or less in diameter, from Japanese medical literature, to analyze the relationships between the diagnostic processes and long-term results. RESULTS: Excluding 3 patients with obstructive jaundice, the other 33 patients did not show any specific initial symptoms. However, 28 (78%) out of 36 patients showed an elevation in serum pancreatic enzyme levels and/or glucose intolerance. Among the 35 patients who had received ultrasonography (US) and/or computed tomography (CT), 20 (57%) patients showed duct dilation alone, whereas only 9 patients (26%) showed tumor mass. Among 35 patients who received an endoscopic retrograde pancreatography (ERP), all patients showed positive findings such as obstruction/stenosis, filling defect or duct dilation. All 36 patients underwent pancreatectomy and the 5-year survival rate was 57%. However, the 5-year survival rate was 34% in the 13 patients with jaundice and/or tumor mass depicted in US/CT, while it was 69% for the 22 patients without these two findings (p < 0.05). CONCLUSIONS: These data lead us to conclude that an elevation of serum pancreatic enzyme levels, glucose intolerance, and duct dilation alone depicted by US/CT should not be overlooked. ERP should be more widely applied to such patients, instead of persisting in delineating the tumor mass by US/CT or follow-up by tumor marker.
Authors: Joshua D Cohen; Ammar A Javed; Christopher Thoburn; Fay Wong; Jeanne Tie; Peter Gibbs; C Max Schmidt; Michele T Yip-Schneider; Peter J Allen; Mark Schattner; Randall E Brand; Aatur D Singhi; Gloria M Petersen; Seung-Mo Hong; Song Cheol Kim; Massimo Falconi; Claudio Doglioni; Matthew J Weiss; Nita Ahuja; Jin He; Martin A Makary; Anirban Maitra; Samir M Hanash; Marco Dal Molin; Yuxuan Wang; Lu Li; Janine Ptak; Lisa Dobbyn; Joy Schaefer; Natalie Silliman; Maria Popoli; Michael G Goggins; Ralph H Hruban; Christopher L Wolfgang; Alison P Klein; Cristian Tomasetti; Nickolas Papadopoulos; Kenneth W Kinzler; Bert Vogelstein; Anne Marie Lennon Journal: Proc Natl Acad Sci U S A Date: 2017-09-05 Impact factor: 11.205
Authors: Anne Marie Lennon; Christopher L Wolfgang; Marcia Irene Canto; Alison P Klein; Joseph M Herman; Michael Goggins; Elliot K Fishman; Ihab Kamel; Matthew J Weiss; Luis A Diaz; Nickolas Papadopoulos; Kenneth W Kinzler; Bert Vogelstein; Ralph H Hruban Journal: Cancer Res Date: 2014-06-12 Impact factor: 12.701
Authors: Ganepola Ap Ganepola; John R Rutledge; Paritosh Suman; Anusak Yiengpruksawan; David H Chang Journal: World J Gastrointest Oncol Date: 2014-01-15