Diagnosis of pancreatic ductal carcinoma
- VernacularTitle:Нойр булчирхайн сувгийн хавдар
- Author:
Susumu Hijioka
;
Kazuo Hara
;
Nobumasa Mizuno
;
Hiroshi Imaoka
;
Kenji Yamao
- Collective Name:Department of Gastroenterology, Aichi Cancer Center Hospital 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi 464-8681, Japan
- Publication Type:journal article
- From:Innovation
2014;8(4):100-101
- CountryMongolia
- Language:Mongolian
-
Abstract:
Pancreatic ductal adenocarcinoma (PDAC) is the most lethal type of gastrointestinal
cancer, with a 5-year survival rate of 5%; it remains a significant, unresolved
therapeutic challenge. Its aggressive features include insidious presentation,
unresectability due to early involvement of major vessels, debilitating symptoms
at the late stage and de novo chemoresistance.
However, according to the Japan Pancreatic Cancer Registry, the 5-year survival
of UICC Stages 0 and 1a are 85.8% and 68.7%, respectively.
Early diagnosis plays an important role in improving the overall survival of
patients with PDAC; therefore, efforts should focus on early diagnosis and the
reliable identification of patients who will most likely benefit from major surgical
intervention.
Patients with risk factors, including family history, accompanying disease,
diabetes mellitus, chronic pancreatitis and intraductal papillary mucinous
neoplasms (IPMN), should be followed up for early detection of PDAC. In Japan,
a national team has undertaken such surveillance of patients with IPMN. The
protocol comprises a semi-annual follow up using various modalities to detect
not only IPMN carcinoma, but also PDAC concomitant with IPMN. I will address
this protocol in detail.
The most accurate imaging technique for PDAC diagnosis and staging is
considered to be contrast-enhanced computed tomography (CECT). Whereas
CT should be the first choice in patients with suspected PDAC, endoscopic
ultrasound (EUS) is the most accurate, particularly for detecting small lesions (<
10 mm). EUS combines the potential of endoscopy, which enables visualization
of the mucosal surface of the gastrointestinal (GI) tract, with ultrasonography.
Thus, EUS is able to provide detailed, high-resolution images of the pancreas.
However, whether a lesion is malignant or benign is unable to be discriminated
solely from EUS imaging features. Obtaining samples from suspicious lesions or
lymph nodes using EUS-guided fine-needle aspiration (FNA), offers the potential
for cytological or histological diagnoses of pancreatic lesions with high sensitivity
and specificity. Since accurate preoperative evaluation is essential to select the
appropriate management strategy, the roles of EUS and EUS-FNA are crucial.
Stage 0 PDAC (carcinoma in situ) has recently been discovered. This stage of PDAC
is unable to be diagnosed using EUS-FNA, because EUS-FNA is only applicable
after PDAC forms a cancerous mass (worse than stage1). Thus, diagnostic methods
other than imaging require development. Presently, endoscopic retrograde
pancreatography (ERP) combined with cytology is able to detect Stage 0 PDAC,
and in Japan, nasopancreatic drainage tubes have recently been used to collect
pancreatic juice for cytodiagnosis. I would also like to introduce this method.
