This type of cancer has a high mortality, and the overall survival is also low. In these conditions, researchers are always looking for improving the therapy.
In this presentation, we mention the histological types of pancreatic cancer, the importance of systemic therapy for operable cases pre- and post-surgeryand of chemotherapy for advanced and metastatic cancer.
New therapeutic agents have been introduced, that appear to give new hope for a more efficient treatment. Acest cancer are o mortalitate ridicată, iar supravieţuirea globală este de asemenea scăzută.
În aceste condiţii, se caută mereu îmbunătăţirea terapiei. În acest articol prezentăm tipurile histologice de cancer al pancreasului, alături de importanţa terapiei sistemice pentru cazurile operabile pre- şi post-chirurgical şi a chimioterapiei pentru boala metastatică.
Dan G. Duda - DF/HCC
Sunt prezentaţi, de asemenea, noi agenţi terapeutici care par a da speranţe pentru un tratament mai eficient. According to Pancreatic Cancer Action Network, there was an alarming increase of pancreatic cancer deaths in the United States of America in The highest incidence of pancreatic cancer is registered in western countries Northern America and Europeand the lowest incidence - in Africa and Asia.
In Romania, the age-standardised rate perpeople was 7.
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Risk factors For exocrine pancreatic cancer Smoking is one of the most important risk factors for pancreatic cancer, overweight and obesity. Other risk factors are: age almost all patients with pancreatic cancer are older than 45 and about two-thirds are at least years-oldgender men are slightly more likely to develop pancreatic cancer than womenrace African Americans are slightly more likely to develop pancreatic cancer than whitesand family history pancreatic cancer seems to run in some families.
Inherited gene changes mutations can be passed from parent to child. Familial pancreatitis, usually caused by mutations in the PRSS1 gene. Peutz-Jeghers syndrome, caused by defects in the STK11 gene.
This syndrome is also linked with polyps in the digestive tract and several other cancers. It can lead to an increased risk of pancreatic cancer and carcinoma of the ampulla of Vater. Pancreatic neuroendocrine tumors and cancers can also be caused by genetic syndromes, such as: Neurofibromatosis, type 1, which is caused by mutations in the NF1 gene.
This syndrome leads to an increased risk for many tumors, including somatostatinomas. This syndrome leads to an increased risk of tumors of the parathyroid gland, the pituitary gland, and the islet cells neuroendocrine cancer treatment in europe the pancreas.
Other conditions incriminated in the occurrence of pancreatic cancer are: diabetes, chronic pancreatitis, liver cirrhosis, ulcer-causing bacterium Helicobacter spital dezalcoolizare bucuresti. Some factors are unclear and induced controversy: diets high in red and processed meatslack of physical activity, coffee, alcohol 4.
Less common types of pancreatic exocrine carcinoma are: adenosquamous carcinomas, squamous cell carcinomas, signet ring cell carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with giant cells. Neuroendocrine tumors of the pancreas functioning NET : gastrinomas, insulinomas, somatostatinomas, VIPomas, PPomas from cells that make pancreatic polypeptide.
Benign and precancerous lesions in the pancreas: serous cystic neoplasms: are almost always benign; mucinous cystadenomas: almost always occur in women and some of them can progress to cancer; intraductal papillary mucinous neoplasms: are benign tumors, they sometimes become cancer if not treated; solid pseudopapillary neoplasms - are benign tumors but need surgical treatment 5.
Treatment Surgical resection offers the only chance of cure for exocrine pancreatic cancer, but only 15 to 20 percent of cases are potentially resectable at presentation.
Local unresectability is usually neuroendocrine cancer treatment in europe not always due to vascular invasion 6. neuroendocrine cancer treatment in europe
We will refer in this presentation mainly to the systemic therapy. For borderline resectable disease, neoadjuvant chemotherapy is indicated 7. A large, multicenter, retrospective analysis published online in February 13th in the Journal of the American College of Surgeons indicates that the addition of adjuvant chemotherapy, but neuroendocrine cancer treatment in europe radiation, reduces the risk for distant recurrences and increases overall survival 9.
After this study, 6 months of gemcitabine became the standard of care in the adjuvant setting of resected pancreatic adenocarcinoma. Because of the positive outcome observed with the use of 5-FU or gemcitabine, the ESPAC-3 trial set out to investigate whether one of these agents was superior to the other. There were no differences in the median OS of approximately 23 months, but 5-FU was associated with a higher rate of grades 3 to 4 toxicity, including neuroendocrine cancer treatment in europe, diarrhea, and myelosuppression Patients receiving GEM have a median survival of 6.
The combinations of GEM and 5-FU or capecitabine, irinotecan, cis- or oxaliplatin do not confer a major advantage in survival even in large randomized phase III trials, neuroendocrine cancer treatment in europe should not be used as standard first line treatment of locally advanced or metastatic pancreatic cancer.
Meta-analysis of randomized trials with a combination of GEM and platinum analogues or of GEM and capecitabine suggested a survival benefit for these combinations for patients with a good PS.
This study concluded that was a suggestion of a beneficial effect on survival in patients with metastatic disease. Immune checkpoint therapy In an analysis made inthe results were not yet conclusive. Most clinical studies on immune checkpoint inhibitors for pancreatic cancer are not yet completed and are still recruiting patients. Among the completed trials, we have data of a preliminary nature such as delayed disease progression and enhanced overall survival after treatment with immune checkpoint inhibitors in mono- or combination therapy.
However, due to small sample sizes, major results are not yet identifiable Bibliografie 1.
Dan G. Duda
Alexander M. Seufferlein, J. Bachet, E. Van Cutsem, P.