ISSN: 2373-6372GHOA

Gastroenterology & Hepatology: Open Access
Commentary
Volume 3 Issue 1 - 2015
Pancreatic Cancer-Early Diagnosis
Nelson Carrillo*
Department of Gastroenterology, Central University of Venezuela, Venezuela
Received: August 4, 2015| Published: November 16, 2015
*Corresponding author: Nelson Carrillo, Central University of Venezuela, Libertador Avenue, Angostura Building, 7 Floor, Office 7B, Caracas, Venezuela, Tel: 58-212-7632202; Fax: 58-212-9917903; E-mail: ,
Citation: Carrillo N (2015) Pancreatic Cancer-Early Diagnosis. Gastroenterol Hepatol Open Access 3(1): 00070. DOI: 10.15406/ghoa.2015.03.00070

Introduction

Various artists and celebrities have died by the disease, Luciano Pavarotti a famous tenor, Henry Mancini composer of music for films and TV series, Steve Jobs founder of Apple Company, and Patrick Swayze actor and star of numerous movies. Its is a fact that often, the diagnosis is made at late stage of the disease, when they are advanced, 85-90 % of cases are inoperable, with a average life of 10-20 months [1].

The pancreatic echo sonography must be well done, fully showing the morphology of the páncreas, the best plane in the transversal in the upper abdomen, in deep inspiration, observing the head, body and tail in front of the splenic vein (Figure 1). It is very important to note superior mesenteric artery, because this vessel divides the páncreas in a cefalo-corporal and a corpocaudal areas, 75 % of neoplasms of the páncreas are in the first zone and 25% in the second. In preparation for this test, antiflatulents the previous day should be used to avoid artifacts gas in the stomach, duodenum and splenic flexure of the colon, causing inadequate observation. We use the RULE OF THREE: All pancreatic size greater than 3 centimeters is abnormal and should be studied. All pancreatic duct greater than 3 millimeters is abnormal and should be studied.

Figure 1: Head, body and tail of the normal pancreas.

Sonographic Detection of Pancreatic Cancer

  1. Direct Signs (Figure 2)
    1. Focal growth
    2. Irregularities of the shape
    3. Focal hypoechoic parenchyma
  2. Indirect signs
    1. Pancreatic duct dilatation (Figures 3-4)
    2. Dilatation of bile ducts (Figures 5-6)
  3.  Vascular compression or invasión (Figure 7)
  4. Lymphnode or liver metastases (Figure 8)

Clearly it shows that the direct signs indicate a better prognosis and indirect signs indicate bad prognosis with a short survival and high mortality.

Cancer of the páncreas in early stage

Localized tumor only in the páncreas with a size less than 3.4 cms (+-0.4 cms) or 3 cms or 2 cms [2,3]
Or stage 1: T1 No Mo

Figure 2: Solitary tumor lesion in the body of the pancreas.
Figure 3: Dilatation of the Wirsung duct, cancer in the head.
Figure 4: Dilatacion of the Wirsung duct, big cancer in the head
Figure 5: Dilatation of bile ducts.
Figure 6: Dilatation of the common bile duct.
Figure 7: Compresion and invasion of the splenic vein.
Figure 8: Several Hepatic metastatic lesions.

Population at high risk for pancreatic cáncer

  1. Age over 65 years
  2. Smoking habits [4]
  3. Crisis of previous pancreatitis [5]
  4. Diabetics [6,7]
  5. Alcoholism
  6. Ca 19-9 high or in rising trend (Normal: 0-37 IU/ml) [8,9]
  7. Genome proneto cáncer of the páncreas [10]

Suggestion

Make determination of Ca 19-9 and pancreatic periodic echo sonography every 6 months in the high risk group. This procedure will permit to make early diagnoses and guide patients suspected to complementary tests: EUS, PCRE, NMR, TAC, fine needle puncture and cytology, percutaneous biopsy or guided by endoscopic sonography and preoperatory laparoscopy.

We encourage the medical groups interested in improving the prognosis of cáncer of the páncreas, to plan a study protocol with this suggestion and observe the results.

References

  1. Richards EJ (2013) Molecular diagnosis of pancreatic cáncer. Cancer growth and progression 16: 259-282.
  2. Ikeda M, Okada S, Tokuuye K, Ueno H, Okusaka T (2001) Prognostic factors in patient with locally advanced pancreatic carcinoma receiving chemoradiotherapy. Cancer 91(3): 490-495.
  3. Sahani DV, Shah ZK, Catalano OA, Boland GW, Brugge WR (2008) Radiology of the pancreatic adenocarcinoma: Current status of imaging. J Gastroenterol Hepatol      23(1): 23-33.
  4. Kuper H, Boffetta P, Adami HO (2002) Tobacco use and cancer causation association by tumor tipe. J Int Med 252(3): 206-224.
  5. Hidalgo M (2010) Pancreatic cáncer. N Eng JMed 362(17): 1605-1617.
  6. Baghurst P, McMichael AJ, Slavotinek AH, Baghurst KI, Peter Boyle, et al. (1991) A case-control study of diet and cáncer of the páncreas. Am J Epidemiol 134(2): 167-179.
  7. AGA: medical position statement (1999) Epidemiology, diagnosis and treatment of pancreatic ductal adenocarcinoma. Gastroenterology 117: 1463-1484.
  8. Glenn J, Steinberg WM, Kurtzman SH, Steinberg SM, Sindelar WF (1988) Evaluation of the utility of a radioimmuno assay for serum Ca19-19 levels in patients before and after treatment of carcinoma of the pancreas. J Clin Oncol 6(3): 462-468.
  9. Ramia JM (1999) Ca 19-9, Cirugia de páncreas. Cir esp 66: 23-27.
  10. Wolpin BM, Rizzato C, Kraft P, Kooperberg C, Petersen GM, et al. (2014) Genome-wide Association study identifies multiple suceptibilitiy loci for pancreatic cáncer. Nature Genetics 46: 994-1000.
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