Pancreatic cancer affects men twice as frequently as women and is more likely to develop after the age of 40. Pancreatic cancer risks increase with chronic pancreatitis, diabetes mellitus, genetic factors. When early diagnosis and early treatment are possible, however, survival chances increase often goes undetected until it is too late to treat effectively.
The most common cause of acute pancreatitis is blockage of the pancreatic duct by a gallstone.
Chronic pancreatitis, associated most often with gall bladder disease and alcoholism, can cause painful attacks over a number of years and lead to other problems, such as pancreatic insufficiency , bacterial infections, and type 2 diabetes.
When eating food that has been cooked or processed, you need to chew your food properly and take digestive enzyme supplements with every meal. This is vital for diabetics as your our pancreas is already unable to keep up with demands placed upon it. When enzyme-free, undigested food enters the small intestine, everything falls upon the poor overworked pancreas. The pancreas is forced to draw reserves from the entire body in order to provide enough enzymes for digestion.
Wednesday, September 27, 2006
Monday, September 18, 2006
pancreas diseases
Pancreatitis is inflammation of the pancreas that may occur as an acute, painful attack, or may be a chronic condition developing gradually over time. It is caused when pancreatic enzyme secretions build up and begin to digest the organ itself. Another term for this condition is auto digestion, which occurs when, for some unknown reason, the pancreas' powerful enzymes are activated in the pancreas itself rather than in the duodenum. It is believed that trypsin sets off a domino effect, activating other enzymes to speed the auto digestive process. There are a variety of tests that physicians use to determine if pancreatic disorders are present, what kinds and how advanced they are, and what may be causing the problem.
Abdominal Ultrasound The technologist who performs the exam, called a sonographer, spreads a gel on the skin's surface and then passes a hand-held instrument called a transducer around the surface of the abdomen. The gel enables smooth manipulation of the transducer and helps to transmit the sound waves by excluding air. MRI is another non-invasive diagnostic procedure commonly prescribed at the Pancreas Center. MRI combines the use of a large magnet and radio waves to create body images. The hydrogen atoms in a patient's body react to the magnetic field, a computer reads the resulting data and organizes the results into images that can be read by the radiologist.
Abdominal Ultrasound The technologist who performs the exam, called a sonographer, spreads a gel on the skin's surface and then passes a hand-held instrument called a transducer around the surface of the abdomen. The gel enables smooth manipulation of the transducer and helps to transmit the sound waves by excluding air. MRI is another non-invasive diagnostic procedure commonly prescribed at the Pancreas Center. MRI combines the use of a large magnet and radio waves to create body images. The hydrogen atoms in a patient's body react to the magnetic field, a computer reads the resulting data and organizes the results into images that can be read by the radiologist.
Monday, September 11, 2006
pancreas diseases : Development of a blood test for pancreatic cancer pt2
Final Report
Pancreatic cancer is one of the most lethal of human diseases. It is the fourth leading cause of cancer-related death among men and women in the United States. The average five-year survival rate is less than 5%. In 1999, the expected death rate includes 2,700 California residents and 28,600 individuals in the United States of America.
Numerous scientific studies designed to reveal the causes of pancreatic cancer have consistently identified cigarette smoking as a significant risk factor. In fact, cigarette smoking remains the only well-established risk factor for pancreatic cancer. The risk of pancreatic cancer appears to correlate with the amount of cigarette smoking. These findings have been supported by experiments in the laboratory. When laboratory rats are fed chemicals derived from tobacco, cancers of the lung and pancreas result. Thus cigarette smoking can cause pancreatic cancers.
At this time, the only therapy for pancreatic cancer is surgical removal early in the course of the disease. Unfortunately, pancreatic cancer is usually discovered when symptoms appear and the disease is far advanced. The diagnosis of pancreatic cancer currently requires sophisticated medical technology. A simple blood test that is able to indicate whether pancreatic cancer is present would represent a major step toward the early diagnosis of pancreatic cancer. The early diagnosis of pancreatic cancer followed by surgery is currently the only hope for patient survival.
Studies supported by the TRDRP enabled our laboratory to develop a blood test for a protein, GP2, which is made only in the pancreas and is released into the bloodstream with pancreatic disease. Our previous success with laboratory animal models of pancreatic diseases led to the efforts toward developing a similar blood test for humans with pancreatic cancer. The development of the antibodies for this project required the cloning of the human GP2 gene, which was used to produce the protein in cultured cell lines. The protein was then used to immunize mice, from which the subsequent antibodies were derived. With the availability of the necessary reagents, we were successful in developing a sensitive test for GP2. Normal GP2 blood levels were established using human subjects without a history of pancreatic disease.
Our initial result with 20 patients with pancreatic disease showed that the average GP2 level was significantly elevated in patients with pancreatic cancer and other pancreatic diseases. The sensitivity of the test in our small sample of patients was 60%, which was approximately equivalent to CA19-9, the most commonly used marker for pancreatic disease at this time. The sensitivity is less than the desired 80% level needed to be used as a screening tool. The assay was correct 70% of the time when used to detect any type of pancreatic disease. Whether the GP2 assay will be useful in pancreatic cancer or other pancreatic diseases will be determined as more patients are enrolled in the future.
by Anson Lowe , M.D. -
Pancreatic cancer is one of the most lethal of human diseases. It is the fourth leading cause of cancer-related death among men and women in the United States. The average five-year survival rate is less than 5%. In 1999, the expected death rate includes 2,700 California residents and 28,600 individuals in the United States of America.
Numerous scientific studies designed to reveal the causes of pancreatic cancer have consistently identified cigarette smoking as a significant risk factor. In fact, cigarette smoking remains the only well-established risk factor for pancreatic cancer. The risk of pancreatic cancer appears to correlate with the amount of cigarette smoking. These findings have been supported by experiments in the laboratory. When laboratory rats are fed chemicals derived from tobacco, cancers of the lung and pancreas result. Thus cigarette smoking can cause pancreatic cancers.
At this time, the only therapy for pancreatic cancer is surgical removal early in the course of the disease. Unfortunately, pancreatic cancer is usually discovered when symptoms appear and the disease is far advanced. The diagnosis of pancreatic cancer currently requires sophisticated medical technology. A simple blood test that is able to indicate whether pancreatic cancer is present would represent a major step toward the early diagnosis of pancreatic cancer. The early diagnosis of pancreatic cancer followed by surgery is currently the only hope for patient survival.
Studies supported by the TRDRP enabled our laboratory to develop a blood test for a protein, GP2, which is made only in the pancreas and is released into the bloodstream with pancreatic disease. Our previous success with laboratory animal models of pancreatic diseases led to the efforts toward developing a similar blood test for humans with pancreatic cancer. The development of the antibodies for this project required the cloning of the human GP2 gene, which was used to produce the protein in cultured cell lines. The protein was then used to immunize mice, from which the subsequent antibodies were derived. With the availability of the necessary reagents, we were successful in developing a sensitive test for GP2. Normal GP2 blood levels were established using human subjects without a history of pancreatic disease.
Our initial result with 20 patients with pancreatic disease showed that the average GP2 level was significantly elevated in patients with pancreatic cancer and other pancreatic diseases. The sensitivity of the test in our small sample of patients was 60%, which was approximately equivalent to CA19-9, the most commonly used marker for pancreatic disease at this time. The sensitivity is less than the desired 80% level needed to be used as a screening tool. The assay was correct 70% of the time when used to detect any type of pancreatic disease. Whether the GP2 assay will be useful in pancreatic cancer or other pancreatic diseases will be determined as more patients are enrolled in the future.
by Anson Lowe , M.D. -
pancreas diseases : Development of a blood test for pancreatic cancer pt1
Initial Award Abstract
Pancreatic cancer is one of the most lethal of human diseases. It is the fourth leading cause of cancer-related death among men and women in the United States. Death normally occurs within a few months after the cancer is discovered.
Numerous scientific studies designed to reveal the causes of pancreatic cancer have consistently identified cigarette smoking as a significant risk factor. In fact, cigarette smoking remains the only well-established risk factor for pancreatic cancer. The risk of pancreatic cancer appears to correlate with the amount of cigarette smoking. These findings have been supported by experiments using laboratory animals, thus showing that cigarette smoking can cause pancreatic cancers.
At this time, the only therapy for pancreatic cancer is surgical removal of the tumor early in the course of the disease. Unfortunately, pancreatic cancer is usually discovered after the disease is far advanced. The diagnosis of pancreatic cancer currently requires sophisticated medical technology. A simple blood test that is able to indicate whether pancreatic cancer is present would represent a major step toward the early diagnosis of pancreatic cancer. The early diagnosis of pancreatic cancer followed by surgery is currently the only hope for patient survival.
A blood test for pancreatic cancer may also help physicians follow the course of the disease. As new therapies are developed to treat pancreatic cancer, a blood test that can monitor cancer growth or regression would be very useful to monitor the progress of the patient. A similar test that measures the blood levels of a protein named prostate specific antigen has already been developed for prostate cancer. This test has proven to be invaluable for the detection and monitoring of prostate cancer.
Initial studies in our laboratory focused on the development a blood test for a protein, GP2, which is made only in the pancreas and is released into the bloodstream with pancreatic disease. In view of our previous successes, our efforts will now be devoted toward developing a similar blood test for humans with pancreatic diseases. If successful, the test will result in the early detection of pancreatic cancer and improve the chances of a cure for these patients. The test will also provide a means to measure the progress of the cancer as new therapies are developed in the future.
Anson Lowe , M.D
Pancreatic cancer is one of the most lethal of human diseases. It is the fourth leading cause of cancer-related death among men and women in the United States. Death normally occurs within a few months after the cancer is discovered.
Numerous scientific studies designed to reveal the causes of pancreatic cancer have consistently identified cigarette smoking as a significant risk factor. In fact, cigarette smoking remains the only well-established risk factor for pancreatic cancer. The risk of pancreatic cancer appears to correlate with the amount of cigarette smoking. These findings have been supported by experiments using laboratory animals, thus showing that cigarette smoking can cause pancreatic cancers.
At this time, the only therapy for pancreatic cancer is surgical removal of the tumor early in the course of the disease. Unfortunately, pancreatic cancer is usually discovered after the disease is far advanced. The diagnosis of pancreatic cancer currently requires sophisticated medical technology. A simple blood test that is able to indicate whether pancreatic cancer is present would represent a major step toward the early diagnosis of pancreatic cancer. The early diagnosis of pancreatic cancer followed by surgery is currently the only hope for patient survival.
A blood test for pancreatic cancer may also help physicians follow the course of the disease. As new therapies are developed to treat pancreatic cancer, a blood test that can monitor cancer growth or regression would be very useful to monitor the progress of the patient. A similar test that measures the blood levels of a protein named prostate specific antigen has already been developed for prostate cancer. This test has proven to be invaluable for the detection and monitoring of prostate cancer.
Initial studies in our laboratory focused on the development a blood test for a protein, GP2, which is made only in the pancreas and is released into the bloodstream with pancreatic disease. In view of our previous successes, our efforts will now be devoted toward developing a similar blood test for humans with pancreatic diseases. If successful, the test will result in the early detection of pancreatic cancer and improve the chances of a cure for these patients. The test will also provide a means to measure the progress of the cancer as new therapies are developed in the future.
Anson Lowe , M.D
Monday, September 04, 2006
pancreas diseases : Sphincter of Oddi dysfunction
SOD is a common cause of unexplained pancreatitis in patients seen in referral centres.[9] Endoscopic manometry can demonstrate separate biliary and pancreatic sphincters and there can be a discordance between the basal pressures in the two sphincters, with one normal and the other elevated. Silverman et al[10] reviewed the results of manometry in 111 patients with pancreaticobiliary pain, most of whom had normal liver and pancreatic chemistries. Manometry was possible in both sphincters in 88 (79%) patients; 28 (32%) patients had elevated pressure in both sphincters; and 15 (17%) patients demonstrated a discordance, with elevated pressure in one of the two sphincters. The clinical implication is that dual-sphincter manometry may be required when evaluating for unexplained pancreatitis and pancreatic sphincterotomy rather than biliary sphincterotomy may be required in some patients to relieve the pain.
A classification of pancreatitis-associated SOD has been proposed that is analogous to biliary SOD[11] : type I patients have recurrent attacks of pancreatitis (confirmed clinically and biochemically) with a dilated pancreatic duct and slow drainage. These patients appear to have stenotic lesions, do not require sphincter of Oddi manometry for diagnosis, and have the best results from sphincterotomy. Type II patients have acute relapsing pancreatitis and no evidence for stenosis other than tonic sphincter of Oddi pressures more than 40 mm Hg on manometric testing. Type III patients have pancreatic type of pain and no evidence of pancreatitis but an abnormal sphincter of Oddi manometry. Type III patients are least likely to respond to sphincterotomy. Pancreatic sphincterotomy should not be undertaken lightly because it is associated with a postprocedural pancreatitis in 11% of patients and a 14% restenosis rate.
by R BAIJAL
A classification of pancreatitis-associated SOD has been proposed that is analogous to biliary SOD[11] : type I patients have recurrent attacks of pancreatitis (confirmed clinically and biochemically) with a dilated pancreatic duct and slow drainage. These patients appear to have stenotic lesions, do not require sphincter of Oddi manometry for diagnosis, and have the best results from sphincterotomy. Type II patients have acute relapsing pancreatitis and no evidence for stenosis other than tonic sphincter of Oddi pressures more than 40 mm Hg on manometric testing. Type III patients have pancreatic type of pain and no evidence of pancreatitis but an abnormal sphincter of Oddi manometry. Type III patients are least likely to respond to sphincterotomy. Pancreatic sphincterotomy should not be undertaken lightly because it is associated with a postprocedural pancreatitis in 11% of patients and a 14% restenosis rate.
by R BAIJAL
pancreas diseases : Occult Biliary Stone Disease or Crystals
Biliary microlithiasis is a significant cause of unexplained acute pancreatitis. In two prospective studies,[5,6] microscopic evaluation of bile was performed in patients convalescing from idiopathic pancreatitis who had no evidence of cholelithiasis. Two thirds of patients had microscopic evidence of cholesterol or calcium bilirubinate crystals; patients with bilirubinate crystals demonstrated sludge on transcutaneous sonography. Importantly patients with microlithiasis had significantly fewer recurrent attacks of pancreatitis when treated with cholecystectomy, endoscopic sphincterotomy, or ursodeoxycholic acid.
Idiopathic Pancreatitis
Gallstone disease and alcohol abuse cause 75% to 80% of all cases of pancreatitis. Including metabolic causes, drug-induced disease, trauma, and viral illness, only approximately 10% of cases of acute pancreatitis remain idiopathic or unexplained.[7] ERCP has an important role in the evaluation of patients with idiopathic disease. Because ERCP is an invasive procedure with well-defined complications, the following question arises: In which patients is ERCP indicated? Most authorities agree that ERCP is indicated:
After two or more mild attacks of acute pancreatitis.
After the first attack of severe acute pancreatitis.
After the first attack of pancreatitis if a patient is more than 45 years of age because the risk for neoplasm increases with age.
Acute, unexplained pancreatitis is the initial presentation in an estimated 3% of patients with pancreatic cancer.[8]
A wide variety of abnormalities may be found on ERCP as causes of pancreatitis and include:
Choledochocoele
Chronic pancreatitis
Intraductal papillary mucinous tumour (IPMT)
Occult stone disease
Pancreas divisum (PD)
Pancreatic cancer
Periampullary tumour
Sphincter of Oddi dysfunction (SOD)
A complete ERCP study in the setting of idiopathic pancreatitis includes:
1.Careful endoscopic examination of the papilla to rule out an ampullary neoplasm or a choledochocoele
2. Complete cholangiography and pancreatography to rule out occult biliary stone disease, chronic pancreatitis, aberrant biliary pancreatic junction, PD and malignant obstruction of the pancreatic duct.
3. Sphincter of Oddi manometry of the biliary and pancreatic sphincters.
In the largest endoscopic series of patients evaluated for idiopathic recurrent acute pancreatitis,[9] 44 of the 116 (38%) patients had an abnormality that could explain the pancreatitis:
72 (62%) No abnormality
17 (14.7%) SOD
11 (9.5%) PD
8 (6.9%) Cholelithiasis
4 (3.4%) Choledochocoele
3 (2.6%) Ampullary tumour
1 (0.8%) Pancreatic duct stricture
by R BAIJAL
Idiopathic Pancreatitis
Gallstone disease and alcohol abuse cause 75% to 80% of all cases of pancreatitis. Including metabolic causes, drug-induced disease, trauma, and viral illness, only approximately 10% of cases of acute pancreatitis remain idiopathic or unexplained.[7] ERCP has an important role in the evaluation of patients with idiopathic disease. Because ERCP is an invasive procedure with well-defined complications, the following question arises: In which patients is ERCP indicated? Most authorities agree that ERCP is indicated:
After two or more mild attacks of acute pancreatitis.
After the first attack of severe acute pancreatitis.
After the first attack of pancreatitis if a patient is more than 45 years of age because the risk for neoplasm increases with age.
Acute, unexplained pancreatitis is the initial presentation in an estimated 3% of patients with pancreatic cancer.[8]
A wide variety of abnormalities may be found on ERCP as causes of pancreatitis and include:
Choledochocoele
Chronic pancreatitis
Intraductal papillary mucinous tumour (IPMT)
Occult stone disease
Pancreas divisum (PD)
Pancreatic cancer
Periampullary tumour
Sphincter of Oddi dysfunction (SOD)
A complete ERCP study in the setting of idiopathic pancreatitis includes:
1.Careful endoscopic examination of the papilla to rule out an ampullary neoplasm or a choledochocoele
2. Complete cholangiography and pancreatography to rule out occult biliary stone disease, chronic pancreatitis, aberrant biliary pancreatic junction, PD and malignant obstruction of the pancreatic duct.
3. Sphincter of Oddi manometry of the biliary and pancreatic sphincters.
In the largest endoscopic series of patients evaluated for idiopathic recurrent acute pancreatitis,[9] 44 of the 116 (38%) patients had an abnormality that could explain the pancreatitis:
72 (62%) No abnormality
17 (14.7%) SOD
11 (9.5%) PD
8 (6.9%) Cholelithiasis
4 (3.4%) Choledochocoele
3 (2.6%) Ampullary tumour
1 (0.8%) Pancreatic duct stricture
by R BAIJAL
pancreas diseases : ENDOSCOPIC MANAGEMENT
Endoscopic techniques are used increasingly in the management of acute and chronic pancreatitis. In many instances surgery can be avoided by endoscopic intervention as in endoscopic drainage of pseudocysts. Other conditions that can be managed by endoscopy include biliary calculi in acute biliary pancreatitis, pancreatic duct disruptions, strictures or stones and treatment of potential causes of pancreatitis such as sphincter of Oddi dysfunction and pancreas divisum. Despite widespread use of these endoscopic techniques, there are few controlled studies comparing pancreatic endotherapy with either surgical intervention or medical treatment.
Management of patients with acute recurrent and chronic pancreatitis is hampered by our incomplete understanding of the pathogenesis of pancreatic inflammation and mechanism of pancreatic pain. The short term assessment of therapies is made more difficult due to the relapsing and remitting nature of pain in pancreatic disease. Therefore, a detailed understanding of the natural history of pancreatitis is required prior to undertaking endoscopic treatment of pancreatic diseases.
BILIARY PANCREATITIS
Gallstone disease is one of the most common causes of acute pancreatitis. Although most episodes are mild and resolve spontaneously, in some patients, severe pancreatitis with local and systemic complications develop and may lead to death in 10% to 15% patients.
A pathbreaking, randomized, controlled study by Neoptolemos and Carr-Locke[1] showed significantly lower complication (24% vs 61%) and mortality (4% vs 18%) rates and a shorter mean length of hospital stay (LOS; 9.5 vs 17 days) in patients with predicted severe pancreatitis who underwent ERCP with sphincterotomy and stone extraction within 72 hours compared with patients who received supportive medical management. Early ERCP had no beneficial effect on patients with mild pancreatitis. The mechanism by which patients with severe pancreatitis benefit from ERCP is unclear as ERCP cannot reverse the damage already done to the pancreas. It has been suggested that patients with severe pancreatitis have a high prevalence of residual common bile duct (CBD) stones which may lead to superimposed cholangitis or continue to irritate the pancreas. Endoscopic removal of these residual stones should benefit these patients.
Several other studies have shown different results. Fan et al[2] in a similar randomized trial from Hong Kong reported no significant difference in complication or mortality rate with respect to pancreatitis, but early ERCP did protect against cholangitis, which occurs in 9% to 10% of patients. In a German multicentre study[3] patients with biliary pancreatitis, excluding those with biliary obstruction or cholangitis, were randomized to ERCP within 72 hours or to noninvasive therapy. There was no significant difference in mortality or overall complication rate, but the ERCP group had more severe complications, especially respiratory failure. This study has been criticized because it excluded the patients most likely to benefit from endoscopic therapy, and because it was a multicentre study, not all hospitals had a high degree of experience in performing ERCP in acute settings.
Despite conflicting data, there is a strong consensus that patients who have predicted severe pancreatitis with evidence of a CBD stone or biliary obstruction benefit from urgent ERCP when performed by experienced operators. A meta-analysis[4] with pooled data showed a 34.6% relative risk reduction for complications and a 42.9% relative risk reduction for death in patients treated with urgent ERCP, sphincterotomy and stone extraction.
by R BAIJAL
Management of patients with acute recurrent and chronic pancreatitis is hampered by our incomplete understanding of the pathogenesis of pancreatic inflammation and mechanism of pancreatic pain. The short term assessment of therapies is made more difficult due to the relapsing and remitting nature of pain in pancreatic disease. Therefore, a detailed understanding of the natural history of pancreatitis is required prior to undertaking endoscopic treatment of pancreatic diseases.
BILIARY PANCREATITIS
Gallstone disease is one of the most common causes of acute pancreatitis. Although most episodes are mild and resolve spontaneously, in some patients, severe pancreatitis with local and systemic complications develop and may lead to death in 10% to 15% patients.
A pathbreaking, randomized, controlled study by Neoptolemos and Carr-Locke[1] showed significantly lower complication (24% vs 61%) and mortality (4% vs 18%) rates and a shorter mean length of hospital stay (LOS; 9.5 vs 17 days) in patients with predicted severe pancreatitis who underwent ERCP with sphincterotomy and stone extraction within 72 hours compared with patients who received supportive medical management. Early ERCP had no beneficial effect on patients with mild pancreatitis. The mechanism by which patients with severe pancreatitis benefit from ERCP is unclear as ERCP cannot reverse the damage already done to the pancreas. It has been suggested that patients with severe pancreatitis have a high prevalence of residual common bile duct (CBD) stones which may lead to superimposed cholangitis or continue to irritate the pancreas. Endoscopic removal of these residual stones should benefit these patients.
Several other studies have shown different results. Fan et al[2] in a similar randomized trial from Hong Kong reported no significant difference in complication or mortality rate with respect to pancreatitis, but early ERCP did protect against cholangitis, which occurs in 9% to 10% of patients. In a German multicentre study[3] patients with biliary pancreatitis, excluding those with biliary obstruction or cholangitis, were randomized to ERCP within 72 hours or to noninvasive therapy. There was no significant difference in mortality or overall complication rate, but the ERCP group had more severe complications, especially respiratory failure. This study has been criticized because it excluded the patients most likely to benefit from endoscopic therapy, and because it was a multicentre study, not all hospitals had a high degree of experience in performing ERCP in acute settings.
Despite conflicting data, there is a strong consensus that patients who have predicted severe pancreatitis with evidence of a CBD stone or biliary obstruction benefit from urgent ERCP when performed by experienced operators. A meta-analysis[4] with pooled data showed a 34.6% relative risk reduction for complications and a 42.9% relative risk reduction for death in patients treated with urgent ERCP, sphincterotomy and stone extraction.
by R BAIJAL
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