4 research outputs found
Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium
Surgical oncolog
International cancer of the pancreas screening (CAPS) consortium summit on the management of patients with increased risk for familial pancreatic cancer
textabstractBackground Screening individuals at increased risk for
pancreatic cancer (PC) detects early, potentially curable,
pancreatic neoplasia.
Objective To develop consortium statements on
screening, surveillance and management of high-risk
individuals with an inherited predisposition to PC.
Methods A 49-expert multidisciplinary international
consortium met to discuss pancreatic screening and vote
on statements. Consensus was considered reached if
≥75% agreed or disagreed.
Results There was excellent agreement that, to be
successful, a screening programme should detect and
treat T1N0M0 margin-negative PC and high-grade
dysplastic precursor lesions (pancreatic intraepithelial
neoplasia and intraductal papillary mucinous neoplasm). It
was agreed that the following were candidates for
screening: first-degree relatives (FDRs) of patients with
PC from a familial PC kindred with at least two affected
FDRs; patients with Peutz–Jeghers syndrome; and p16,
BRCA2 and hereditary non-polyposis colorectal cancer
(HNPCC) mutation carriers with ≥1 affected FDR.
Consensus was not reached for the age to initiate
screening or stop surveillance. It was agreed that initial
screening should include endoscopic ultrasonography
(EUS) and/or MRI/magnetic resonance
cholangiopancreatography not CT or endoscopic
retrograde cholangiopancreatography. There was no
consensus on the need for EUS fine-needle aspiration to
evaluate cysts. There was disagreement on optimal
screening modalities and intervals for follow-up imaging.
When surgery is recommended it should be performed at
a high-volume centre. There was great disagreement as
to which screeni
Management of patients with increased risk for familial pancreatic cancer: updated recommendations for the international cancer of the pancreas screening (CAPS) (vol 68, pg 7, 2020)
Cellular mechanisms in basic and clinical gastroenterology and hepatolog
Timeline of Development of Pancreatic Cancer and Implications for Successful Early Detection in High-Risk Individuals
BACKGROUND & AIMS: To successfully implement imaging-based pancreatic cancer (PC) surveillance, understanding the timeline and morphologic features of neoplastic progression is key. We aimed to investigate the progression to neoplasia from serial prediagnostic pancreatic imaging tests in high-risk individuals and identify factors associated with successful early detection. METHODS: We retrospectively examined the development of pancreatic abnormalities in high-risk individuals who were diagnosed with PC or underwent pancreatic surgery, or both, in 16 international surveillance programs. RESULTS: Of 2552 high-risk individuals under surveillance, 28 (1%) developed neoplastic progression to PC or high-grade dysplasia during a median follow-up of 29 months after baseline (interquartile range [IQR], 40 months). Of these, 13 of 28 (46%) presented with a new lesion (median size, 15 mm; range 7-57 mm), a median of 11 months (IQR, 8; range 317 months) after a prior examination, by which time 10 of 13 (77%) had progressed beyond the pancreas. The remaining 15 of 28 (54%) had neoplastic progression in a previously detected lesion (12 originally cystic, 2 indeterminate, 1 solid), and 11 (73%) had PC progressed beyond the pancreas. The 12 patients with cysts had been monitored for 21 months (IQR, 15 months) and had a median growth of 5 mm/y (IQR, 8 mm/y). Successful early detection (as high-grade dysplasia or PC confined to the pancreas) was associated with resection of cystic lesions (vs solid or indeterminate lesions (odds ratio, 5.388; 95% confidence interval, 1.525-19.029) and small lesions (odds ratio, 0.890/mm; 95% confidence interval 0.812-0.976/mm). CONCLUSIONS: In nearly half of high-risk individuals developing high-grade dysplasia or PC, no prior lesions are detected by imaging, yet they present at an advanced stage. Progression can occur before the next scheduled annual examination. More sensitive diagnostic tools or a different management strategy for rapidly growing cysts are needed