Dilemmas in the management of screen-detected lesions in patients at high risk for pancreatic cancer

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• 作者：Isaura S. Ibrahim ; Bert A. Bonsing ; Rutger-Jan Swijnenburg…
• 关键词：Pancreatic ductal adenocarcinoma ; PDAC ; Genetic predisposition ; CDKN2A mutation ; p16 ; Leiden mutation ; Surveillance ; Pylorus ; preserving pancreaticoduodenectomy ; Complications
• 刊名：Familial Cancer
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：16
• 期：1
• 页码：111-115
• 全文大小：756KB
• 刊物类别：Medicine
• 刊物主题：Cancer Research; Human Genetics; Epidemiology; Biomedicine, general;
• 出版者：Springer Netherlands
• ISSN：1573-7292
• 卷排序：16

文摘

In 3–5 % of all cases of pancreatic ductal adenocarcinoma (PDAC), hereditary factors influence etiology. While surveillance of high-risk individuals may improve the prognosis, this study describes two very different outcomes in patients with screen-detected lesions. In 2000, a surveillance program of carriers of a CDKN2A/p16-Leiden-mutation consisting of annual MRI was initiated. Patients with a suspected pancreatic lesion undergo CT-scan and Endoscopic Ultrasound, and surgery is offered when a lesion is confirmed. In 2015, two patients with a screen-detected solid lesion were identified. In both patients, lesions were visible on MRI and CT scan, while the EUS was unremarkable. Surgical resection of the head of the pancreas resulted in nearly fatal complications in the first patient. This patient was shown to have a benign lesion. In contrast, timely identification of an early cancer in the second patient was accompanied by an uneventful postoperative course. These cases underline the risks inherent to a PDAC prevention program. All patients should be fully informed about the possible outcomes before joining a surveillance program.