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Mendis S, Lipton L, To YH, Ananda S, Michael M, McLachlan SA, Thomson B, Loveday B, Knowles B, Fox A, Nikfarjam M, Usatoff V, Shapiro J, Clarke K, Pattison S, Chee CE, Zielinski R, Wong R, Gibbs P, Lee B. Early onset pancreatic cancer-exploring contemporary treatment and outcomes using real-world data. Br J Cancer 2024; 130:1477-1484. [PMID: 38448752 PMCID: PMC11058801 DOI: 10.1038/s41416-024-02619-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Pancreatic cancer incidence is increasing in younger populations. Differences between early onset pancreatic cancer (EOPC) and later onset pancreatic cancer (LOPC), and how these should inform management warrant exploration in the contemporary setting. METHODS A prospectively collected multi-site dataset on consecutive pancreatic adenocarcinoma patients was interrogated. Patient, tumour, treatment, and outcome data were extracted for EOPC (≤50 years old) vs LOPC (>50 years old). RESULTS Of 1683 patients diagnosed between 2016 and 2022, 112 (6.7%) were EOPC. EOPC more frequently had the tail of pancreas tumours, earlier stage disease, surgical resection, and trended towards increased receipt of chemotherapy in the curative setting compared to LOPC. EOPC more frequently received 1st line chemotherapy, 2nd line chemotherapy, and chemoradiotherapy than LOPC in the palliative setting. Recurrence-free survival was improved for the tail of pancreas EOPC vs LOPC in the resected setting; overall survival was superior for EOPC compared to LOPC across the resected, locally advanced unresectable and metastatic settings. CONCLUSIONS EOPC remains a small proportion of pancreatic cancer diagnoses. The more favourable outcomes in EOPC suggest these younger patients are overall deriving benefits from increased treatment in the curative setting and increased therapy in the palliative setting.
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Affiliation(s)
- Shehara Mendis
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
| | | | - Yat Hang To
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- University of Melbourne, Parkville, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Sumitra Ananda
- University of Melbourne, Parkville, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Michael Michael
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Sue-Anne McLachlan
- University of Melbourne, Parkville, VIC, Australia
- Department of Medical Oncology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Benjamin Thomson
- Department of Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Benjamin Loveday
- Department of Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Brett Knowles
- Department of Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
- Epworth Healthcare, Melbourne, VIC, Australia
| | - Adrian Fox
- Department of Hepatobiliary Surgery, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Mehrdad Nikfarjam
- University of Melbourne, Parkville, VIC, Australia
- Department of Hepatobiliary Surgery, Austin Health, Heidelberg, VIC, Australia
| | | | - Julia Shapiro
- Department of Medicine, Alfred Hospital, Prahran, VIC, Australia
| | - Kate Clarke
- Department of Medical Oncology, Wellington Hospital, Wellington, New Zealand
| | - Sharon Pattison
- Department of Medicine, Dunedin School of Medicine, University of Otago, Otago, New Zealand
| | - Cheng Ean Chee
- Department of Hematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Rob Zielinski
- Department of Medical Oncology, Orange Hospital, Orange, NSW, Australia
- Department of Medical Oncology, Dubbo Base Hospital, Dubbo, NSW, Australia
- Department of Medical Oncology, Bathurst Base Hospital, West Bathurst, NSW, Australia
| | - Rachel Wong
- Epworth Healthcare, Melbourne, VIC, Australia
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
- Department of Medical Oncology, Eastern Health, Box Hill, VIC, Australia
| | - Peter Gibbs
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- University of Melbourne, Parkville, VIC, Australia
| | - Belinda Lee
- Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- University of Melbourne, Parkville, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
- Department of Medical Oncology, Northern Hospital, Epping, VIC, Australia
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Nguyen TK, Nguyen HH, Luong TH, Dang KK, Le VD, Trinh HS, Tran DD. Total laparoscopic radical antegrade modular pancreato-splenectomy with left-posterior superior mesenteric artery first-approach for distal pancreatic cancer: step-by-step technique with a surgical case report (with video). World J Surg Oncol 2022; 20:224. [PMID: 35787283 PMCID: PMC9254562 DOI: 10.1186/s12957-022-02657-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/26/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Left-sided pancreatic cancers are uncommon but seem more aggressive than tumors of pancreatic head. Radical antegrade modular pancreato-splenectomy (RAMPS) was proved to have safe and effective advantages while comparing with standard retrograde pancreato-splenectomy (SRPS) in recent systematic literature reviews and meta-analyses. Laparoscopic SMA first-approach RAMPS was recently proceeded with optimistic perioperative outcomes. CASE PRESENTATION Our patient is a 67-year-old female with a medical history of diabetes and hypertension, recruited because of upper left quadrant abdominal pain. She was referred for pancreato-splenectomy because of a 3-cm-sized mass in distal pancreas. We use 5 trocars and the patient placed in a Trendelenburg position. The retroperitoneum is opened at the left-posterior side of the meso-pancreato-duodenum along to the inframesocolic space, so that the anterior surface of the aorta (AO), inferior vena cave (IVC), left renal vein (LRV), left adrenal grand (LAG), and kidney are completely exposed. The inferior border of the pancreas had been dissected and separated from the superior mesenteric vein (SMV) below the pancreatic isthmus, removed the lymph nodes (LNs) groups 14v and 17. Then, dissect of LNs groups 7,8,9,11p,12 en bloc at the superior side of the pancreas. Dissection of LNs group 14p, d or SMA LNs after transecting the pancreas. The operation time was 240 min, the estimated blood loss was 200 ml. With no postoperative complications as well as no diarrhea, the patient was discharged on the POD10 uneventfully. Pathological result: pancreatic ductal adenocarcinoma with T2N1 staging and negative margin (R0). CONCLUSIONS This technique was safe and effective to perform precise and complete lymphadenectomy and negative posterior resection in total laparoscopic left-posterior SMA first-approach RAMPS for distal pancreatic cancer.
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Affiliation(s)
- Thanh Khiem Nguyen
- Department of Gastrointestinal and Hepato-pancreato-biliary surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Ham Hoi Nguyen
- Department of Gastrointestinal and Hepato-pancreato-biliary surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Tuan Hiep Luong
- Department of Surgery, Hanoi Medical University, 1st Ton That Tung Street, Dong Da, Ha Noi, 11521, Vietnam.
| | - Kim Khue Dang
- Department of Gastrointestinal and Hepato-pancreato-biliary surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Van Duy Le
- Department of Gastrointestinal and Hepato-pancreato-biliary surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Hong Son Trinh
- Department of Oncology, Viet Duc University Hospital, Hanoi, Vietnam
| | - Duc Dung Tran
- Department of Surgery, Thai Binh Medical University, Thai Binh, Vietnam
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Hashmi SSH, Trusty RK, Mora MCF, Abushahin A, Winters H. A Unique Case of Invasive Adenocarcinoma of the Body and Tail of the Pancreas Presenting as Gastric Outlet Obstruction. Cureus 2022; 14:e23154. [PMID: 35433144 PMCID: PMC9007278 DOI: 10.7759/cureus.23154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/05/2022] Open
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Petenyi FG, Garay T, Muhl D, Izso B, Karaszi A, Borbenyi E, Herold M, Herold Z, Szasz AM, Dank M. Modulated Electro-Hyperthermic (mEHT) Treatment in the Therapy of Inoperable Pancreatic Cancer Patients-A Single-Center Case-Control Study. Diseases 2021; 9:diseases9040081. [PMID: 34842668 PMCID: PMC8628793 DOI: 10.3390/diseases9040081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/03/2021] [Accepted: 10/30/2021] [Indexed: 02/05/2023] Open
Abstract
Our present oncological treatment arsenal has limited treatment options for pancreatic ductal adenocarcinoma (PDAC). Extended reviews have shown the benefits of hyperthermia for PDAC, supporting the perspectives with the improvements of the treatment possibilities. METHODS: A retrospective single-center case-control study was conducted with the inclusion of 78 inoperable PDAC patients. Age-, sex-, chemotherapy-, stage-, and ascites formation-matched patients were assigned to two equal groups based on the application of modulated electro-hyperthermia (mEHT). The EHY2030 mEHT device was used. RESULTS: A trend in favor of mEHT was found in overall survival (p = 0.1420). To further evaluate the potential beneficial effects of mEHT, the presence of distant metastasis or ascites in the patients’ oncological history was investigated. Of note, mEHT treatment had a favorable effect on patients’ overall survival in metastatic disease (p = 0.0154), while less abdominal fluid responded to the mEHT treatment in a more efficient way (p ≤ 0.0138). CONCLUSION: mEHT treatment was associated with improved overall survival in PDAC in our single-center retrospective case-control study. The outcome measures encourage us to design a randomized prospective clinical study to further confirm the efficiency of mEHT in this patient cohort.
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Affiliation(s)
- Flora Greta Petenyi
- Faculty of Information Technology and Bionics, Pazmany Peter Catholic University, 1083 Budapest, Hungary; (F.G.P.); (T.G.); (B.I.)
| | - Tamas Garay
- Faculty of Information Technology and Bionics, Pazmany Peter Catholic University, 1083 Budapest, Hungary; (F.G.P.); (T.G.); (B.I.)
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (D.M.); (A.K.); (E.B.); (Z.H.); (A.M.S.)
| | - Dorottya Muhl
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (D.M.); (A.K.); (E.B.); (Z.H.); (A.M.S.)
| | - Blanka Izso
- Faculty of Information Technology and Bionics, Pazmany Peter Catholic University, 1083 Budapest, Hungary; (F.G.P.); (T.G.); (B.I.)
| | - Adam Karaszi
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (D.M.); (A.K.); (E.B.); (Z.H.); (A.M.S.)
| | - Erika Borbenyi
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (D.M.); (A.K.); (E.B.); (Z.H.); (A.M.S.)
| | - Magdolna Herold
- Department of Internal Medicine and Hematology, Semmelweis University, 1088 Budapest, Hungary;
| | - Zoltan Herold
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (D.M.); (A.K.); (E.B.); (Z.H.); (A.M.S.)
| | - Attila Marcell Szasz
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (D.M.); (A.K.); (E.B.); (Z.H.); (A.M.S.)
| | - Magdolna Dank
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary; (D.M.); (A.K.); (E.B.); (Z.H.); (A.M.S.)
- Correspondence: ; Tel.: +36-1-266-0926
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Maloney S, Itchins M, Arena J, Sahni S, Howell VM, Hayes SA, Gill AJ, Clarke SJ, Samra J, Mittal A, Pavlakis N. Optimal Upfront Treatment in Surgically Resectable Pancreatic Cancer Candidates: A High-Volume Center Retrospective Analysis. J Clin Med 2021; 10:2700. [PMID: 34207372 PMCID: PMC8235361 DOI: 10.3390/jcm10122700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/17/2022] Open
Abstract
Pancreatic adenocarcinoma is a devastating disease with only 15-20% of patients resectable at diagnosis. Neoadjuvant chemotherapy for this cohort is becoming increasingly popular; however, there are no published randomized trials that support the use of neoadjuvant chemotherapy over upfront surgery in resectable disease. This retrospective cohort analysis was conducted to compare both treatment pathways and to identify any potential prognostic markers. Medical records from one large volume pancreatic cancer center from 2013-2019 were reviewed and 126 patients with upfront resectable disease were analyzed. Due to a change in practice in our center patients treated prior to December 2016 received upfront surgery and those treated after this date received neoadjuvant chemotherapy. Of these, 86 (68%) patients were treated with upfront surgery and 40 (32%) of patients were treated with neoadjuvant chemotherapy. Our results demonstrated that patients treated with upfront surgery with early-stage (1a) disease had a longer median OS compared to those treated with neoadjuvant chemotherapy (24 vs. 21 months, p = 0.028). This survival difference was not evident for all patients (regardless of stage). R0 resections were similar between groups (p = 0.605). We identified that both tumor viability (in neoadjuvant chemotherapy-treated patients) and tumor grade were useful prognostic markers. Upfront surgery for certain patients with low volume disease may be suitable despite the global trend towards neoadjuvant chemotherapy for all upfront resectable patients. A prospective clinical trial in this cohort incorporating biomarkers is needed to determine optimal therapy pathway.
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Affiliation(s)
- Sarah Maloney
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia; (M.I.); (J.A.); (S.S.); (V.M.H.); (S.A.H.); (A.J.G.); (S.J.C.); (J.S.); (A.M.); (N.P.)
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, The University of Sydney, Sydney, NSW 2065, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, Sydney, NSW 2065, Australia
| | - Malinda Itchins
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia; (M.I.); (J.A.); (S.S.); (V.M.H.); (S.A.H.); (A.J.G.); (S.J.C.); (J.S.); (A.M.); (N.P.)
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, The University of Sydney, Sydney, NSW 2065, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, Sydney, NSW 2065, Australia
| | - Jennifer Arena
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia; (M.I.); (J.A.); (S.S.); (V.M.H.); (S.A.H.); (A.J.G.); (S.J.C.); (J.S.); (A.M.); (N.P.)
- Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, Sydney, NSW 2065, Australia
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St. Leonards, Sydney, NSW 2065, Australia
| | - Sumit Sahni
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia; (M.I.); (J.A.); (S.S.); (V.M.H.); (S.A.H.); (A.J.G.); (S.J.C.); (J.S.); (A.M.); (N.P.)
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, The University of Sydney, Sydney, NSW 2065, Australia
| | - Viive M. Howell
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia; (M.I.); (J.A.); (S.S.); (V.M.H.); (S.A.H.); (A.J.G.); (S.J.C.); (J.S.); (A.M.); (N.P.)
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, The University of Sydney, Sydney, NSW 2065, Australia
| | - Sarah A. Hayes
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia; (M.I.); (J.A.); (S.S.); (V.M.H.); (S.A.H.); (A.J.G.); (S.J.C.); (J.S.); (A.M.); (N.P.)
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, The University of Sydney, Sydney, NSW 2065, Australia
| | - Anthony J. Gill
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia; (M.I.); (J.A.); (S.S.); (V.M.H.); (S.A.H.); (A.J.G.); (S.J.C.); (J.S.); (A.M.); (N.P.)
- Cancer Diagnosis and Pathology Group, Kolling Institute, The University of Sydney, Sydney, NSW 2065, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St. Leonards, Sydney, NSW 2065, Australia
| | - Stephen J. Clarke
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia; (M.I.); (J.A.); (S.S.); (V.M.H.); (S.A.H.); (A.J.G.); (S.J.C.); (J.S.); (A.M.); (N.P.)
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, The University of Sydney, Sydney, NSW 2065, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, Sydney, NSW 2065, Australia
| | - Jaswinder Samra
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia; (M.I.); (J.A.); (S.S.); (V.M.H.); (S.A.H.); (A.J.G.); (S.J.C.); (J.S.); (A.M.); (N.P.)
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, The University of Sydney, Sydney, NSW 2065, Australia
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St. Leonards, Sydney, NSW 2065, Australia
| | - Anubhav Mittal
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia; (M.I.); (J.A.); (S.S.); (V.M.H.); (S.A.H.); (A.J.G.); (S.J.C.); (J.S.); (A.M.); (N.P.)
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, The University of Sydney, Sydney, NSW 2065, Australia
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, St. Leonards, Sydney, NSW 2065, Australia
| | - Nick Pavlakis
- Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia; (M.I.); (J.A.); (S.S.); (V.M.H.); (S.A.H.); (A.J.G.); (S.J.C.); (J.S.); (A.M.); (N.P.)
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, The University of Sydney, Sydney, NSW 2065, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, Sydney, NSW 2065, Australia
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Burns EA, Kasparian S, Khan U, Abdelrahim M. Pancreatic adenocarcinoma with early esophageal metastasis: A case report and review of literature. World J Clin Oncol 2020; 11:83-90. [PMID: 32133277 PMCID: PMC7046924 DOI: 10.5306/wjco.v11.i2.83] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/23/2019] [Accepted: 12/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic adenocarcinoma is an aggressive malignancy with a high propensity to metastasize. Esophageal metastasis manifesting as dysphagia is rarely reported in the literature and has not to our knowledge been reported prior to the appearance of the primary disease.
CASE SUMMARY A patient presented with progressive dysphagia to solids and a persistent earache. Computed tomography of the neck and chest revealed a 3.0 cm × 1.8 cm heterogeneous mass originating from the upper third of the esophagus, necrotic cervical and supraclavicular lymphadenopathy, and bilateral pulmonary nodules. She underwent a core needle biopsy of a right cervical node, which suggested a well-differentiated adenocarcinoma of unknown primary. She had an upper endoscopy with biopsy of the esophageal mass suggestive of a well-differentiated adenocarcinoma. Positron emission tomography imaging revealed increased uptake in the esophageal mass, cervical, and mediastinal lymph nodes. She was started on folinic acid, fluorouracil, and oxaliplatin. Prior to initiation of cycle 8, the patient was found to have a pancreatic body mass that was not present on prior radiographic imaging, confirmed by endoscopic ultrasonography and biopsy to be pancreatic adenocarcinoma. CA19-9 was > 10000 U/mL, suggesting a primary pancreaticobiliary origin.
CONCLUSION Esophageal metastasis diagnosed before primary pancreatic adenocarcinoma is rare. This case highlights the profound metastatic potential of pancreatic adenocarcinoma.
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Affiliation(s)
- Ethan Alexander Burns
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, United States
| | - Saro Kasparian
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, United States
| | - Usman Khan
- Department of Oncology, Houston Methodist Cancer Center, Houston, TX 77030, United States
| | - Maen Abdelrahim
- Department of Oncology, Houston Methodist Cancer Center, Houston, TX 77030, United States
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Rahman M, Washington L. The seemingly innocuous presentation of metastatic pancreatic tail cancer: a case report. J Med Case Rep 2019; 13:178. [PMID: 31182138 PMCID: PMC6558877 DOI: 10.1186/s13256-019-2125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/16/2019] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Pancreatic cancers of the tail have an especially poor prognosis due to their late detection. An earlier diagnosis depends on a better understanding of the clinical course of the disease; however, much of the current literature focuses on pancreatic head adenocarcinomas owing to their higher incidence. Thus, we add our case report to the current literature of pancreatic tail cancers in the hope of aiding earlier detection. We present an interesting case of a patient who initially presented with innocuous abdominal pain and a single episode of vomiting who was subsequently diagnosed with metastatic pancreatic tail cancer. CASE PRESENTATION A 56-year-old Hispanic man with a past medical history of alcohol and cocaine abuse was initially evaluated in our clinic after presenting to the emergency department with sudden onset of abdominal pain and one episode of emesis. On further questioning, he stated that he had been experiencing dull, intermittent left back pain for the past 2-3 years. Laboratory tests were performed, which showed that the patient had new-onset diabetes, and imaging revealed a pancreatic tail mass with metastases to the liver. Biopsy confirmed the diagnosis of stage IV metastatic pancreatic tail adenocarcinoma. During follow-up 1 month later, the patient reported that he had been largely asymptomatic since his hospital admission; however, his left back pain had increased in severity. He was then started on a FOLFIRINOX chemotherapy regimen (5-fluorouracil/leucovorin, irinotecan, and oxaliplatin). CONCLUSIONS There are many pitfalls in the diagnosis of pancreatic cancer, especially pancreatic tail cancer due to its vague symptoms. Thus, pancreatic cancer of the tail often presents late with a very poor prognosis. Because there is currently no widespread screening for pancreatic cancer, it is often difficult for practitioners to identify pancreatic tail cancers. Current research suggests that there is a strong association between new-onset diabetes after the age of 50 and pancreatic cancer, and tumors detected at the onset of diabetes are favorable to resection. Pancreatic cancer has also been shown to be associated with certain risk factors, such as smoking, high body mass index, chronic pancreatitis, and a family history of pancreatic cancer. Thus, when patients with presentations similar to our patient's with new-onset diabetes after the age of 50, along with vague symptoms such as back or abdominal pain as well as the presence of risk factors, we suggest that it is beneficial for practitioners to maintain a high index of suspicion for pancreatic cancer.
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Saad AM, Turk T, Al-Husseini MJ, Abdel-Rahman O. Trends in pancreatic adenocarcinoma incidence and mortality in the United States in the last four decades; a SEER-based study. BMC Cancer 2018; 18:688. [PMID: 29940910 PMCID: PMC6020186 DOI: 10.1186/s12885-018-4610-4] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 06/19/2018] [Indexed: 12/11/2022] Open
Abstract
Background Pancreatic cancer is the fourth-leading cause of cancer deaths in the United States. The silent nature of the disease and its poor prognosis, the need for further research, along with the need to assess the outcomes of current approaches necessitate an ongoing evaluation of the epidemiology and mortality-trends of this malignancy. Continuous monitoring of disease-patterns, on population-levels, may help scientists assess the quality of healthcare delivery, boost their understanding of diseases' characteristics and risk factors, and detect gaps whereby further research is needed. None of the previous reports shed light on pancreatic adenocarcinomas (PAC), the most common type of Pancreatic Cancer, as the primary outcome. In this study we aim to investigate PAC’s incidence and mortality trends over the last four decades in the United States. Methods We used SEER 9 database to study PAC cases during 1974-2014. Incidence and mortality rates were calculated by sex, age, race, state and stage of PAC. Annual percent change (APC) was calculated using joinpoint regression software. Results We reviewed 67,878 PAC cases; most of these cases were in the head of pancreas. Overall PAC incidence rates increased 1.03% (95% CI, 0.86-1.21, p <.001) per year over the study period. Rates of adenocarcinoma of the head of pancreas increased 0.87% (95% CI, 0.68-1.07, p <.001), and rates of adenocarcinoma of the body and tail of pancreas increased 3.42% (95% CI, 3.06-3.79, p <.001) per year during 1973-2014. PAC incidence-based mortality increased 2.22% (95% CI, 1.93-2.51, p <.001) per year. However, during 2012-2014 there was a statistically significant decrease in PAC incidence-based mortality; APC, -24.70% (95% CI, -31.78 - -16.88, p <.001). Conclusion PAC’s incidence and mortality rates have been increasing for decades. However, the last few years have shown a promising decrease in mortality. We believe that further advances in healthcare delivery and research can lead to a further mortality decrease. Future studies can use this paper as a baseline to keep monitoring the outcomes of PAC's therapy. Electronic supplementary material The online version of this article (10.1186/s12885-018-4610-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anas M Saad
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Tarek Turk
- Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Lofty Elsayed Street, Cairo, 11566, Egypt. .,Department of Oncology, University of Calgary and Tom Baker Cancer Center, Calgary, Alberta, Canada.
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Vaithianathan R, Panneerselvam S, Santhanam R. Anaplastic carcinoma of the pancreas: is there a role for palliative surgical procedure? Indian J Palliat Care 2014; 20:50-2. [PMID: 24600183 PMCID: PMC3931242 DOI: 10.4103/0973-1075.125560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Anaplastic carcinoma (AC) or undifferentiated carcinoma of the pancreas is a rare variant among the malignant pancreatic neoplasms. These tumors have a poor prognosis with survival measured in months. The role of surgical palliation to improve the quality of life is not well defined in these patients. We report a case of AC of pancreas in a 65-year-old male patient. Patient had upper abdominal pain with frequent bilious vomiting. Computed tomography scan of the abdomen showed a mass in the body of pancreas with possible infiltration of duodenojejunal flexure (DJF). Laparotomy revealed an inoperable mass with posterior fixity and involvement of the DJF. Patient underwent a palliative duodenojejunostomy. Tissue biopsy from the tumor showed pleomorphic type AC with giant cells. Patient had good symptomatic relief from profuse vomiting and progressed well at follow up. AC of pancreas is a rare and aggressive malignancy with dismal outlook. If obstructive symptoms are present due to duodenal involvement, a palliative bypass may be a worthwhile surgical option in selected cases.
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Affiliation(s)
- Rajan Vaithianathan
- Department of General Surgery, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Senthil Panneerselvam
- Department of General Surgery, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Ramachandran Santhanam
- Department of General Surgery, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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Shrikhande SV, Barreto SG. Surgery for pancreatic carcinoma: state of the art. Indian J Surg 2012; 74:79-86. [PMID: 23372311 PMCID: PMC3259176 DOI: 10.1007/s12262-011-0373-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 11/10/2011] [Indexed: 02/06/2023] Open
Abstract
Carcinoma of the pancreas remains a malignancy with a generally dismal outcome owing to the delayed presentation of the disease. To date, surgery affords the best outcomes when a complete resection can be achieved. Improvements in imaging, surgical techniques and adjuvant therapies are perceived advancements in the management of this cancer. This article reviews the latest evidence in terms of the diagnosis and management of pancreatic cancer.
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Affiliation(s)
- Shailesh V. Shrikhande
- Department of GI and HPB Surgical Oncology, Tata Memorial Centre, Ernest Borges Marg, Parel, Mumbai, 400012 India
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