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Irreversible Electroporation in Patients with Pancreatic Cancer :Angel and Devil

Jiyoung KEUM ; Hee Seung LEE ; Huapyong KANG ; Jung Hyun JO ; Moon Jae CHUNG ; Jeong Youp PARK ; Seung Woo PARK ; Si Young SONG ; Seungmin BANG

Journal of Digestive Cancer Report.2019;7(1):26-30.

Pancreatic cancer has a very poor prognosis. Complete surgical resection remains the only current curative treatment. Locally advanced pancreatic cancer (LAPC) is considered as unresectable because of involvement of celiac and/or mesenteric vessels. The treatment of LAPC is a challenge. Current guidelines suggest systemic therapy. However, the majority of patients will never experience conversion to surgical resection. Thus, in these patients, ablation is an alternative therapy for local control, which causes local destruction while ideally avoiding injury to surrounding healthy tissue. Irreversible electroporation (IRE) is an energy delivery system, effective in ablating tumors by inducing irreversible membrane destruction of cells. IRE demonstrated to be safe in previous studies. However, it is not free from complications, even serious. Here, we reported two cases of the IRE in LAPC patients.
Electroporation ; Humans ; Membranes ; Pancreatic Neoplasms ; Prognosis

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Extraordinary Response of Metastatic Pancreatic Cancer to Chemotherapy

Dong Woo SHIN ; Jinkook KIM ; Jong Chan LEE ; Jaihwan KIM ; Jin Hyeok HWANG

Journal of Digestive Cancer Report.2019;7(1):22-25.

A 58-year-old woman presented with right flank and back pain for one month. After undergoing an abdominal computed tomography (CT), she was referred to our hospital. The abdominal CT showed a hypodense pancreatic tail mass with multiple retroperitoneal lymph node metastases. Positron emission tomography-computed tomography (PET-CT) scan showed high 18F-FDG uptake in pancreatic tumor and enlarged lymph nodes. Endoscopic ultrasound fine needle aspiration (EUS-FNA) revealed adenocarcinoma, which stained strongly in hENT1 (human equilibrative nucleoside transporter 1) on immunohistochemistry. She received gemcitabine 1,000 mg/m² + nanoparticle albumin-bound paclitaxel 125 mg/m² as a palliative chemotherapy. Follow-up abdominal CT and PET-CT after 4 cycles of chemotherapy showed that both pancreatic mass and the metastatic retroperitoneal lymph nodes were nearly disappeared. We report a case of 58-year-old female with metastatic pancreatic cancer who had a dramatic response to palliative chemotherapy (gemcitabine plus nanoparticle albumin-bound paclitaxel).
Adenocarcinoma ; Albumin-Bound Paclitaxel ; Back Pain ; Biopsy, Fine-Needle ; Drug Therapy ; Electrons ; Female ; Fluorodeoxyglucose F18 ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Lymph Nodes ; Middle Aged ; Nanoparticles ; Neoplasm Metastasis ; Nucleoside Transport Proteins ; Pancreatic Neoplasms ; Tail ; Tomography, X-Ray Computed ; Ultrasonography

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A Case of 47-Years-Old Female with Obstructive Jaundice and Weight Loss

Pil Gyu PARK ; Huapyong KANG ; Moon Jae CHUNG ; Jeong Youp PARK ; Seungmin BANG ; Seung Woo PARK ; Si Young SONG ; Hee Seung LEE

Journal of Digestive Cancer Report.2019;7(1):18-21.

Serine protease inhibitor Kazal-type 1 (SPINK1) is a gene expressed from pancreatic acinar cell which its mutation is known to be associated with chronic pancreatitis (CP) and pancreatic cancer. We report a case of a 47-years-old female with nausea and weight loss with yellow discoloration of skin. Initial imaging and endoscopic study led us to an impression of chronic pancreatitis with pancreatic cancer with common bile-duct dilation. Biopsy result was confirmed with pancreatic adenocarcinoma and additional imaging revealed lymph node and bone metastasis. Our genetic analysis revealed 194+2T>C mutation of SPINK1. Biliary obstruction was successfully decompressed by stent insertion and underwent chemotherapy and radiotherapy. Although there is accumulating evidence of association between SPINK1 mutation and CP, the relationship between SPINK1 mutation and pancreatic cancer in CP patient is an emerging concept. Genetic analysis should be considered in patients with young age especially when diagnosed with both CP and pancreatic cancer.
Acinar Cells ; Adenocarcinoma ; Biopsy ; Drug Therapy ; Female ; Genes, vif ; Humans ; Jaundice, Obstructive ; Lymph Nodes ; Nausea ; Neoplasm Metastasis ; Pancreatic Neoplasms ; Pancreatitis, Chronic ; Radiotherapy ; Serine Proteases ; Skin ; Stents ; Weight Loss

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Clinicopathologic Implication of New AJCC 8(th) Staging Classification in the Stomach Cancer

Sung Eun KIM

Journal of Digestive Cancer Report.2019;7(1):13-17.

Stomach cancer is the fifth most common malignancy in the world. The incidence of stomach cancer is declining worldwide, however, gastric cancer still remains the third most common cause of cancer death. The tumor, node, and metastasis (TNM) staging system has been frequently used as a method for cancer staging system and the most important reference in cancer treatment. In 2016, the classification of gastric cancer TNM staging was revised in the 8(th) American Joint Committee on Cancer (AJCC) edition. There are several modifications in stomach cancer staging in this edition compared to the 7(th) edition. First, the anatomical boundary between esophagus and stomach has been revised, therefore the definition of stomach cancer and esophageal cancer has refined. Second, N3 is separated into N3a and N3b in pathological classification. Patients with N3a and N3b revealed distinct prognosis in stomach cancer, and these results brought changes in pathological staging. Several large retrospective studies were conducted to compare staging between the 7(th) and 8(th) AJCC editions including prognostic value, stage grouping homogeneity, discriminatory ability, and monotonicity of gradients globally. The main objective of this review is to evaluate the clinical and pathological implications of AJCC 8(th) staging classification in the stomach cancer.
Classification ; Esophageal Neoplasms ; Esophagus ; Humans ; Incidence ; Joints ; Methods ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; Stomach

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Various Classification of Gastric Adenocarcinoma

Hee Seok MOON ; Hyun Yong JEONG

Journal of Digestive Cancer Report.2019;7(1):8-12.

Despite its declining incidence, gastric cancer is globally, still, the third most common cause of cancer-related mortality. Gastric cancer is a heterogeneous disease with diverse pathogenesis and molecular backgrounds. Therefore several systems have been proposed to aid in the classification of gastric adenocarcinoma based on the macroscopic, microscopic and anatomical features of the tumor. However, these classifications did not reflect the pathogenesis of the disease. Recently, genomic analysis has identified several subtypes of gastric adenocarcinoma and a detailed understanding of the molecular biology behind the neoplastic phenotype is possible to develop of more effective therapies. We will describe the existing various classification of gastric cancer and the recently introduced molecular biology and immunological classification.
Adenocarcinoma ; Classification ; Incidence ; Molecular Biology ; Mortality ; Phenotype ; Stomach Neoplasms

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Adjuvant Therapy of Pancreatic Cancer

Woo Hyun PAIK

Journal of Digestive Cancer Report.2019;7(1):5-7.

Pancreatic cancer is a lethal disease since curative resection is available in only 20% of patients at the initial diagnosis. Even after radical resection of the cancer, most patients experience recurrence. Therefore, many clinical trials have been attempted to prevent recurrence of pancreatic cancer. The key clinical studies about adjuvant therapy of pancreatic cancer and currently available regimens in Korea will be reviewed concisely according to the chemotherapy, radiation therapy, or both.
Diagnosis ; Drug Therapy ; Humans ; Korea ; Pancreatic Neoplasms ; Recurrence

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Chemotherapy for Patients with Colorectal Cancer - When and How?

Jae Hyun KIM

Journal of Digestive Cancer Report.2019;7(1):1-4.

It is important to choose the appropriate treatment option for patients with colorectal cancer (CRC), because it could affect the prognosis of patients. Chemotherapy is effective in prolonging survival and time to progression in patients with advanced CRC. Adjuvant chemotherapy have been reported to reduce the recurrence rate of colorectal cancer by 30% in patients with stage 3 or high risk of stage 2 CRC. Although palliative chemotherapy does not offer long-term benefits, as life expectancy remains below 12 months in most of those receiving treatment, recent developments in the treatment including target agents and immunotherapy have improved the median overall survival time in patients with metastatic CRC by up to 30 months. Chemotherapy for patients with CRC is classified into neoadjuvant, adjuvant, and palliative therapy according to the status of patients. In this review, I summarized the chemotherapy for patients with CRC, which applying in clinical practice.
Chemotherapy, Adjuvant ; Colorectal Neoplasms ; Drug Therapy ; Humans ; Immunotherapy ; Life Expectancy ; Palliative Care ; Prognosis ; Recurrence

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Appendiceal Mucinous Neoplasm Detected due to the Protrusion of Mucin, in the Absence of Appendiceal Distension: A Case Report

Jin Woo PARK ; Min Geun PARK ; Ji-Sun SONG ; Hyeon Je CHO ; Yu Jin KIM

Journal of Digestive Cancer Report.2020;8(2):109-111.

A mucocele is a cystic dilatation of the vermiform appendix that contains mucous material. The symptoms associated with it are not specific and the diagnosis is seldom made prior to surgery. The reported prevalence in appendectomy specimens procured during surgery is 0.2-0.3%. Recently, we experienced a case of patient with appendiceal mucocele detected by colonoscopic examination. This case did not show typical colonoscopic features of a mucocele, demonstrating protrusion of mucin, in the absence of a smooth mound with normal overlying mucosa surrounding the appendiceal orifice. The case involved a 64-year-old woman who underwent a colonoscopy. An abdominopelvic computed tomography scan suggested a normal appendix. Subsequently, we performed an appendectomy. The pathologic finding was a low-grade appendiceal mucinous neoplasm.

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Effect of Gastric Cancer Screening on Patients with Gastric Cancer:A Nationwide Population-based Study

Young Suk CHO ; Sang Hoon LEE ; Hyun Ju SO ; Dong Wook KIM ; Yoon Jung CHOI ; Han Ho JEON

Journal of Digestive Cancer Report.2020;8(2):102-108.

Background: This study was performed to evaluate the effect of gastric cancer screening through analysis of screening-related data. Methods: We investigated claims data of gastric cancer from 2009 to 2015. We evaluated whether the screening was performed to prior to registration as patients with gastric cancer. The effect of gastric cancer screening was also analyzed by gender. Results: We collected total 196,293 patients with gastric cancer. 74% of them had previous experience of gastric cancer screening. In patients with screening, early gastric cancer was 33.4% and advanced gastric cancer was 17.3%. 22,548 (15.5%) patients were diagnosed with gastric cancer within 2 years after screening. In the case of patients without screening, early gastric cancer was 15.1% and advanced gastric cancer was 25.3%. In case of men, 76% of them confirmed gastric cancer through screening, and 70.2% of women confirmed the gastric cancer. In both men and women, the rate of early gastric cancer was higher among those with screening than those without screening. Conclusion In this study, we were able to indirectly confirm the stage shift of gastric cancer screening. However, within 2 years after screening, not a few patients with gastric cancer were diagnosed. Therefore, more studies are warranted to in the future.

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The Metformin Use and Gastric Cancer Risk

Young-Il KIM

Journal of Digestive Cancer Report.2020;8(2):97-101.

Metformin is a widely used first-line anti-diabetic drug worldwide. Epidemiologic studies using the large population-based cohort database have shown the association between metformin uses and reduced risk of various type cancers including gastric cancer. In the gastric cancer prevention, metformin use was associated with the significant reduction of gastric cancer risk, especially for long-term metformin users. However, there is no well-designed randomized controlled clinical trial investigating the effect of metformin as a chemopreventive drug for gastric cancer. Therefore, further well-designed clinical trials will be needed to implement metformin for chemoprevention of gastric cancer.

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