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Applied Surgical Anatomy
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Vishal G Shelat, Andrew Clayton Lee, Julian Wong, Karen Randhawa, CJ Shukla, Choon Sheong Seow, Tjun Tang
The patient has no distant metastases. Pancreas cancer is resectable. Would you relieve jaundice before surgery or proceed with surgery directly?Operating on patients with jaundice has risks of coagulopathy, renal dysfunction, and wound or abdominal sepsis.Preoperative biliary drainage with ERCP and biliary stenting is an option in patients with deep jaundice. However, it is associated with an increased risk of abdominal and wound sepsis. Hence, its routine use is not advocated. It is indicated when neoadjuvant chemotherapy is planned.Preoperative biliary drainage with PTC is an option; however, this is inconvenient to the patient, not physiologic, leads to fluid-electrolyte deficits, and does not restore enterohepatic circulation.In patients with preoperative biliary drainage, surgery should be deferred for up to 14 days for immune benefits to be restored from enterohepatic circulation and nutritional rehabilitation.
Radiation Hormesis in Cancer
Published in T. D. Luckey, Radiation Hormesis, 2020
There was poor correletion between radiation dose and mortality from rectum and pancreas cancer mortality (Tables 6.12 and 6.13). Mortality from cancer of other digestive organs showed little increase to 50 cGy and a ceiling from 1 to 4 Gy (Table 6.12). Data on liver cancer mortality showed a threshold at 2 Gy. Increased doses of radiation showed no increased mortality from salivary gland or gall bladder cancer in Nagasaki.968 The Hiroshima data were not reported.
The digestive system
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
Approximately 1.5% of individuals will be diagnosed with pancreas cancer during their lifetime. In the United States, pancreatic cancer accounts for about 3% of all cancers in the United States and for about 7% of cancer deaths. The incidence of pancreatic cancer is increasing worldwide. The vast majority of pancreatic cancers arise as adenocarcinomas in the ductal epithelium. Age is a key factor in the development of pancreatic cancer given that it rarely strikes individuals less than 50 years of age. Cigarette smoking, diabetes and chronic pancreatitis also appear to increase the risk of developing pancreatic cancer. Mortality rates are very high and long-term survival is poor.
Emerging kinase inhibitors for the treatment of pancreatic ductal adenocarcinoma
Published in Expert Opinion on Emerging Drugs, 2022
NCI’s Surveillance, Epidemiology, and End Results (SEER) program estimates a total of 62,210 new cases of pancreatic cancer (3.2% of all cancer diagnoses in the U.S.) and 49,830 deaths (8.2% of all cancer-related deaths) in the U.S. in 2022 [1]. Pancreas cancer is one of the few solid organ cancers with currently rising incidence rates [2–4]. Based on projected shifts in demographics and changes in estimated incidence and death rates, pancreas cancer is projected to surpass breast, prostate, and colorectal cancer to become the second leading cause of cancer-related mortality in the U.S [2]. Age-adjusted incidence rates for new pancreas cancer cases and pancreas cancer-related death rates have risen by an average of 0.5% and 0.2% per year over the last decade, and projected incidence and death rates are estimated to increase to 1.3% and 0.5% annually, respectively [1,2]. Based on 2017 to 2019 data, the life-time risk of men and women to be diagnosed with pancreas cancer is ~1.7% [1].
Healthcare use in the year preceding a diagnosis of pancreatic cancer: a register-based cohort study in Denmark
Published in Scandinavian Journal of Primary Health Care, 2022
Linda A. Rasmussen, Line F. Virgilsen, Claus W. Fristrup, Peter Vedsted, Henry Jensen
The present findings of increases in diagnostic investigations and hospital contacts are similar to previous studies [10–12] on healthcare use prior to a cancer diagnosis. Further, a recent Danish study on 11 abdominal cancer types demonstrated increased rates of abdominal ultrasound and CT scans from three to five months before a pancreatic cancer diagnosis [9]. Singh et al. [29] found that it was difficult to identify pancreatic cancer through imaging and that 80% of pancreatic tumours were missed on a CT scan prior to the diagnosis. Furthermore, several scans are often required to ensure sufficient imaging quality for a precise diagnosis and evaluation of cancer stage, even after a suspicion of pancreas cancer has been raised. This may explain part of our findings that patients with pancreatic cancer underwent more specialised diagnostic imaging throughout the entire study period, especially in the last months before the diagnosis, compared to their references.
Rationale for combination of radiation therapy and immune checkpoint blockers to improve cancer treatment
Published in Acta Oncologica, 2019
Olav Dahl, Jon Espen Dale, Marianne Brydøy
An abscopal response was documented after use of carbon-ion radiation in recurrent colorectal cancer [139]. Carbon ion radiation seems to expose more tumor antigens for stimulation of CD8 T-cells and can yield an abscopal response. Pancreas cancer has a grim prognosis despite often limited metastases at presentation. Carbon ion radiation suppresses migration and invasiveness of human pancreatic carcinoma cells in contrast to photon radiation in experimental studies [140]. Carbon-ion radiotherapy combined with surgery is used in clinical trials [141]. When carbon-ion therapy was combined with gemcitabine it yielded 83% local control at 2 years, while the patients died of metastases resulting in only 35% 2-year survival [142]. Selecting carbon ion radiation which can control local tumor growth and simultaneously expose tumor antigens which can be attacked by CD8 T-cells released by ICBs, may, therefore, be a new strategy for pancreatic cancer.