35 research outputs found
International cancer of the pancreas screening (CAPS) consortium summit on the management of patients with increased risk for familial pancreatic cancer
Background 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
â„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 PeutzâJeghers syndrome; and p16,
BRCA2 and hereditary non-polyposis colorectal cancer
(HNPCC) mutation carriers with â„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
Surveillance for pancreatic cancer in high-risk individuals
Background: Surveillance of individuals at high risk of pancreatic ductal adenocarcinoma (PDAC) and its
precursors might lead to better outcomes. The aim of this study was to determine the prevalence
and outcomes of PDAC and high-risk neoplastic precursor lesions among such patients participating
in surveillance programmes.
Methods: A multicentre study was conducted through the International CAncer of the Pancreas Screening (CAPS) Consortium Registry to identify high-risk individuals who had undergone pancreatic resection or progressed to advanced PDAC while under surveillance. High-risk neoplastic precursor lesions
were defined as: pancreatic intraepithelial neoplasia (PanIN) 3, intraductal papillary mucinous neoplasia
(IPMN) with high-grade dysplasia, and pancreatic neuroendocrine tumours at least 2 cm in diameter.
Results: Of 76 high-risk individuals identified in 11 surveillance programmes, 71 had undergone surgery
and five had been diagnosed with inoperable PDAC. Of the 71 patients who underwent resection, 32
(45 per cent) had PDAC or a high-risk precursor (19 PDAC, 4 main-duct IPMN, 4 branch-duct IPMN,
5 PanIN-3); the other 39 patients had lesions thought to be associated with a lower risk of neoplastic
progression. Age at least 65 years, female sex, carriage of a gene mutation and location of a lesion in the
head/uncinate region were associated with high-risk precursor lesions or PDAC. The survival of high-risk
individuals with low-risk neoplastic lesions did not differ from that in those with high-risk precursor
lesions. Survival was worse among patients with PDAC. There was no surgery-related mortality.
Conclusion: A high proportion of high-risk individuals who had surgical resection for screening- or
surveillance-detected pancreatic lesions had a high-risk neoplastic precursor lesion or PDAC
Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium
Surgical oncolog