Relief of Obstruction in the Management of Pancreatic Cancer.
[Relief of Obstruction in the Management of Pancreatic Cancer]. Korean J Gastroenterol. 2019 Aug 25;74(2):69-80 Authors: Kwon CI Abstract Pancreatic cancer is a major cause of cancer-related mortality and morbidity, and its incidence is increasing as the population is aging. On the other hand, significant improvement in the prognosis has not occurred. The absence of early diagnosis means that many patients are diagnosed only when they develop symptoms, such as jaundice, due to a biliary obstruction. The role of endoscopy in multidisciplinary care for patients with pancreatic cancer continues to evolve. Controversy remains regarding the best preoperative biliary drainage in patients with surgically resectable pancreatic head cancer. In general, patients undergoing a surgical resection usually do not require preoperative biliary drainage unless they have cholangitis or receive neoadjuvant chemotherapy. If biliary drainage is performed prior to surgery, the patient's condition and a multidisciplinary approach should be considered. With the increasing life expectancy of patients with pancreatic cancer, the need for more long-time biliary drainage or pre-operative biliary drainage is also increasing. Strong evidence of endoscopic retrograde cholangiopancreatography (ERCP) as a first-line and essential treatment for biliary decompression has been provided. On the other hand, the use of endoscopic ultrasound-guided biliary drainage as well as percutaneous bilia...
AbstractAutoimmune pancreatitis (AIP) is an inflammatory process of the pancreas that occurs most commonly in elderly males and clinically can mimic pancreatic adenocarcinoma and present with jaundice, weight loss, and abdominal pain. Mass-forming lesions in the pancreas are seen in the focal form of AIP and both clinical and imaging findings can overlap those of pancreatic cancer. The accurate distinction of AIP from pancreatic cancer is of utmost importance as it means avoiding unnecessary surgery in AIP cases or inaccurate steroid treatment in patients with pancreatic cancer. Imaging concomitantly with serolo...
Pancreatic cancerPancreatic cancer begins in the pancreas, an organ that secretes enzymes that aid digestion and hormones that regulate the metabolism of sugars. Pancreatic cancer, which typically spreads rapidly to nearby organs, seldom is detected in its early stages. One sign of pancreatic cancer is diabetes, especially when it occurs with weight loss, jaundice or [...]
CONCLUSION: Patients presenting as emergencies with cancers characterised by symptoms/signs tolerable by patients but appropriately alarming to doctors (for example, pancreatic cancer manifesting as painless jaundice) are over-represented among cases whose emergency presentation involved GP referral. Reductions in diagnoses of cancer through an emergency presentation likely reflect both the continually increasing use of 2-week-wait GP referrals during the study period and reductions in emergency GP referrals. PMID: 31455644 [PubMed - as supplied by publisher]
CONCLUSIONAwareness of the entity and use of ancillary techniques in making the pre-operative diagnosis could have saved the patient from an extensive surgical procedure.
Conclusions Neutrophil-to-lymphocyte ratio was significantly higher in patients with IPMN-associated invasive carcinoma as compared with patients with noninvasive disease; however, NLR was not helpful in differentiating between high- and low-grade lesions.
Pancreatic adenocarcinoma is the third leading cause of cancer related death. Data suggests that neoadjuvant chemotherapy prior to resection improves survival. In patients with jaundice, this requires preoperative ERCP with biliary stenting. Some patients with biliary stents develop cholangitis, requiring additional intervention. The impact of preoperative cholangitis on outcomes of patients with pancreatic cancer who undergo surgery is unknown. Here, we evaluated the impact of preoperative cholangitis on post operative outcomes and disease recurrence.
The most common form of pancreatic cancer is pancreatic ductal adenocarcinoma. The long-term outcome of pancreatic cancer is extremely poor: the overall median survival from diagnosis is 3 –6 months without treatment, increasing to around 23 months with resectional surgery and adjuvant treatment. Pancreatic cancer is usually diagnosed late and has a biological phenotype characterized by resistance to all cancer treatment modalities and early metastasis. Jaundice is the most common p resenting symptom.
Conclusions: The EUSGBD seems to be an effective and safe treatment for acute cholecystitis in patients unsuitable for cholecystectomy. It can also be used to treat jaundice caused by obstruction of the common bile duct, when no other methods can be used. The method is particularly promising in cases of concurrent acute cholecystitis and common bile duct obstruction. PMID: 31118983 [PubMed]
ConclusionIn our study, time interval between cancer diagnosis and the initiation of palliative chemotherapy>2 weeks was not associated with a poorer survival outcome for patients with unresectable pancreatic cancer. Our result might help clinicians to clarify that early initiation of palliative chemotherapy might provide survival benefit for patients who present with tumor pain, but not for those who pres ent with jaundice.
ConclusionRacial/ethnic and geographic disparities in access to biliary interventions including ERCP exist for patients with pancreatic cancer in the United States. Our results highlight the need for further research and policies to improve access to appropriate biliary intervention for all patients.