Magyar onkologia最新文献

This review provides an overview about the role of endoscopy in the care of patients suffering from pancreatic cancer. In the field of diagnostics the role of endoscopic ultrasound is highlighted in both solid and cystous pancreatic tumors. The decreasing diagnostic relevance of endoscopic retrograde cholangiopancreatography (ERCP) is also discussed. The issue of preoperative biliary drainage in case of obstruction is negotiated in detail, while palliative settings are appointed thoroughly. Besides conventional enteral stenting in case of gastric outlet syndrome caused by local spreading of pancreatic tumor, some new innovative endoscopic solutions are summarized. Several endoscopic ultrasound-guided antitumor interventions that are mainly in clinical trial phase are referred in the article. The diagnostics and treatment of pancreatic neuroendocrine tumors are discussed separately due to their different biological behavior. The review emphasizes the need for multidisciplinary approach of the patients suffering from malignant pancreatic tumors.

Pancreatic cancer in the narrower sense is defined as pancreatic ductal adenocarcinoma (PDAC), which accounts for 95% of malignancies of the pancreas. The tumor has a very poor prognosis, one of the reasons being that it is often only recognized at an advanced, already metastatic stage. Another reason is that although oncotherapy has developed rapidly in recent decades, there has been no significant improvement in the treatment of these tumors. Based on Hungarian and international analyses, we can expect an increase in the number of patients in the coming decades, so research in any field of medicine is of paramount importance for early diagnosis and the development of more effective treatment strategies. However, it is important to know the other benign and malignant exocrine and neuroendocrine tumors, the precursor lesions, as the basic condition for proper treatment is an accurate pathological diagnosis. The summary presents the pathological diversity of tumors, detailing their macroscopic, microscopic, and immunohistochemical characteristics.

In an increasingly aging Western society, the treatment of the malignant diseases became the greatest challenge of medicine in the 21st century. Among these, pancreatic ductal adenocarcinoma (PDAC) is of particular interest which, in spite of modern oncology treatments, is a malignancy with an unfavorable prognosis. Underlying the poor survival rates, relatively late-stage recognition, limitations of surgical removal, and ineffective oncological treatments can be mentioned. Its importance is further enhanced by its growing incidence. As a consequence of these reasons, there is an increasing effort for the early detection of invasive tumors, the central part of which is the detection and clinical addressing of precancerous conditions in the pancreas. Of these, intraductal papillary mucinous neoplasia (IPMN) has a paramount importance. In this review, we present the latest evidence-based knowledge of the etiological factors, epidemiological features, pathomorphological manifestations, most up-to-date diagnosis and treatment of IPMN.

Pancreatic cancer is a devastating disease, survival rates did not improve during the last decades. At the same time new drugs and chemotherapy regimens have been approved for systemic use lately, the results of targeted therapy and the precision medicine approach are also encouraging. Further progress is needed covering all treatment modalities (surgery, radiotherapy, systemic treatment) in order to improve outcome of patients suffering from pancreatic cancer.

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy. At the time of diagnosis, the cancer is usually at an advanced stage and only a minority of the cases are eligible for surgical resection. To improve prognosis, it is crucial to diagnose and treat the disease at an early stage. This article reviews the cytopathology and histopathology of PDAC and its precursors. The three main aspects of PDAC pathology are the primary confirmation of cancer, the macroscopic and microscopic evaluation of pancreatic resection specimens and molecular testing. It is beneficial to run the diagnostics and to treat the patients at specialized pancreatic cancer centers, where every member of the team is confronted with many cases.

The prognosis of pancreatic cancer is closely related to the histological origin of the tumors and the stage of the disease. As recognition is advanced in most cases, treatment options are limited. The development of nuclear medicine hybrid techniques (SPECT/CT, PET/CT, PET/MRI) and new therapies plays an important role in the recognition and treatment of pancreatic tumors. These measurements are useful in characterizing biological behavior, based on which tumors can be recognized at an early stage, promote the treatment, the selection of optimal therapies (e.g., targeted therapies). The authors discuss the role of nuclear medicine techniques in the management of patients suffering from pancreatic tumors.

Modern imaging procedures, including CT and MR diagnostics, play a significant role in recognizing, characterizing, determining the extent of pancreatic tumor lesions, assessing their operability, and evaluating response to treatment and patient follow-up. This article reviews the conventional imaging modalities used in the modern diagnosis of pancreatic tumors, conventional and contrast-enhanced abdominal ultrasound, standard protocols using the latest research results from CT and MRI scans, and their location and diagnostic value in the treatment of solid and cystic neoplasia. In addition, it briefly discusses the additional possibilities of artificial intelligence-based processing of digital imaging data, which is under strong development and is expected to be incorporated into clinical practice in the future.

The pancreatic ductal adenocarcinoma (PDAC) is responsible for 95% of pancreatic malignancies. It is the 12th most common cancer and is the 7th leading cause of cancer deaths worldwide. The incidence of PDAC is increasing in the USA and in Europe (including Hungary), while mortality rate is not changing too much. The only curative therapeutic possibility is R0 surgical resection. The mortality of pancreatic resections has been decreasing in recent years and can be kept below 5% in HPB centers. The limits of surgical radicality have been extended and the en bloc resection of greater veins around the pancreas is now accepted. The survival could be improved by R0 resection of early cancers without lymph node spread and results can be augmented by combined oncologic therapies.

The therapy of pancreatic cancer is fundamentally based on surgical removal and chemotherapy. The available evidence and results of publications concerning the application of radiotherapy are controversial. Accordingly, the international guidelines formulated by radiation oncology organizations have paramount interest in this particular pathology. Answers are eagerly awaited in several unclear questions from ongoing, or recently closed, yet unpublished trials. Modern radiotherapy techniques, like stereotactic radiotherapy, or actually less available modalities, like particle therapy or magnetic resonance imaging guided radiotherapy show promising results, as well as combination of radiation with immunotherapy.

Insufficient tissue perfusion in malignancies results in hypoxic areas, favoring neoplastic progression. Tumor cells under hypoxia undergo an adaptive program by activating alternative metabolic pathways, which is regulated by hypoxia inducible factor-1 (HIF1) in order to overcome microenvironmental changes. The expression of carbonic anhydrase IX (CAIX) is a prominent protective mechanism against intracellular acidosis occurring in cancer cells suffering from hypoxia. Due to the activity of CAIX, the restored intracellular pH (pHi) supports tumor cell proliferation and migration, while the compensatory extracellular acidosis contributes to immunoprotection and to chemo- and radioresistance. In vitro and animal model experiments showed that the chemotherapeutic efficiency could be significantly improved by the selective inhibition of CAIX, thus, its adjuvant therapeutic potential is under active investigation.