Early Diagnosis Improves Long-Term Disease-Free Survival in Pancreatic Cancer

Martha Kerr

May 22, 2008

May 22, 2008 (San Diego, California) — Endoscopic ultrasound (EUS) plus endoscopic retrograde cholangiopancreatography (ERCP), with immediate resection of the pancreas in high-risk EUS-positive patients, has resulted in some cases of disease-free survival lasting for as long as 4 years.

"The problem with pancreatic cancer is that by the time symptoms appear, the disease is generally pretty advanced," Mark P. Callery, MD, associate professor of surgery at Harvard Medial School in Boston, Massachusetts, commented while moderating a session on the latest advances in the diagnosis and treatment of pancreatic cancer here at Digestive Disease Week 2008.

"Pancreatic cancer is uniformly lethal and one reason is because we can't distinguish between cancer and chronic injury. Approximately 10% of pancreatic cancer is inherited. If the disease is detected early, we think that survival rates could be significantly improved," said Teresa A. Brentnall, MD, associate professor of medicine in the division of gastroenterology at the University of Washington in Seattle, as she presented findings from 100 subjects from 73 familial pancreatic cancer kindreds.

Dr. Brentnall's team has been following the cohort for approximately 10 years. EUS was performed at baseline and has been repeated annually ever since. Patients with distinctly abnormal EUS findings underwent ERCP if there was no cause for pancreatitis, such as heavy alcohol intake or biliary stones.

"We can see microscopic changes with ERCP," Dr. Brentnall explained.

Patients with abnormal EUS and abnormal ERCP results were given the option of a pancreatic biopsy for histologic analysis. Then, those with abnormal histology results were given the option of elective pancreatectomy.

Pancreatectomy was conducted in 4 patients, 3 of whom were found to have widespread carcinoma in situ.

The important finding, Dr. Brentnall said, was that none of the patients with advanced pancreatic precancers who underwent pancreatectomy developed cancer during the 7 years of follow-up.

"The problem is that cancer in the pancreas doesn't develop in just 1 section," the Seattle researcher commented. "It is diffuse, and so the whole pancreas has to be removed."

Of the 4 patients who underwent pancreatectomy, 1 died of hypoglycemia, 2 developed new cancers after 1 year, and 1 developed new cancer after 4 years. Two patients are still alive after 4 years: 1 has cancer and is receiving chemotherapy and 1 is cancer-free, Dr. Brentnall said.

In the cohort overall, survival has improved from the expected duration of 5 months to more than 9 months.

"A combination of EUS and ERCP can aid in the detection of pancreatic neoplasia when performed in a specialized center, and can lead to the detection of curable pancreatic precancer," Dr. Brentnall said.

"None of the patients who were caught early went on to develop cancer," Dr. Brentnall told Medscape Gastroenterology.

"The endoscopic changes that 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."

"Symptoms only develop after advanced disease has developed, and 75% of patients have no chance for a cure," Dr. Callery added.

Dr. Brentnall is an advisor for GlobeImmune, Inc. Dr. Callery has disclosed no relevant financial relationships.

Digestive Disease Week (DDW) 2008: Abstract 664. Presented May 20, 2008.

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