Current Staging Systems for Pancreatic Cancer

From the *Division of Surgical Oncology, Department of Surgery, and †Departmentof Radiology, The Medical College of Wisconsin, Milwaukee, WI.
The Cancer Journal (Impact Factor: 3.61). 11/2012; 18(6):539-49. DOI: 10.1097/PPO.0b013e318278c5b5
Source: PubMed

ABSTRACT Accurate pretreatment staging of pancreatic cancer is a crucial initial step in the development of a stage-specific treatment plan, either on- or off-protocol for any patient with pancreatic cancer. Importantly, current American Joint Committee on Cancer staging utilizes the maximal information available; if surgery has been performed, then pathological information from the resected specimen will provide additional information for both T and N staging. If surgery has not been performed, then staging is based on information from available cross-sectional imaging studies. Although American Joint Committee on Cancer staging was modified in the sixth edition to reflect the survival difference between patients with operable/resectable versus nonoperable/unresectable disease, the precise definitions of resectability continue to evolve. It is essential for clinicians of different specialties to understand the definitions of resectability to facilitate optimal patient care and to allow for accurate interpretation of the literature. This review focuses on important aspects of the pretreatment assessment of patients with particular attention to definitions of resectability. Computed tomography has become the optimal imaging modality for pancreatic cancer staging, but other adjunct studies, including endoscopic ultrasound and laparoscopy, may provide additional staging information especially in circumstances where computed tomography technology is limited. In addition, the process of a standardized pathological review is summarized, with emphasis on assessment of the superior mesenteric artery margin and the definitions of R0, R1, and R2. Finally, the prognostic importance of key components of the pathological report such as lymph node status, lymph node ratio, and treatment effect is reviewed.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC), a common digestive system cancer, is highly malignant and has a poor disease outcome. Currently, all available examination and detection methods cannot accurately predict the clinical outcome. Therefore, it is extremely important to identify novel molecular biomarkers for personalized medication and to significantly improve the overall outcome. The "noncoding RNAs" (ncRNAs) are a group of RNAs that do not code for proteins, and they are categorized as structural RNAs and regulatory RNAs. It has been shown that microRNAs and long ncRNAs function as regulatory RNAs to affect the progression of various diseases. Many studies have confirmed a role for ncRNAs in the progression of PDAC during the last few years. Because of the significant role of ncRNAs in PDAC, ncRNA profiling may be used to predict PDAC outcome with high accuracy. This review comprehensively analyzes the value of ncRNAs as potential biomarkers to predict the outcome in PDAC and the possible mechanisms thereof.
    Drug Design, Development and Therapy 02/2015; 9:1247-1255. DOI:10.2147/DDDT.S77597 · 3.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The relationship of a pancreatic head cancer to the superior mesenteric–portal vein (SMPV) confluence has intrigued and confused surgeons and oncologists for decades. The foundation for this ongoing debate began with Whipple, who described the operation of pancreaticoduodenectomy (PD) in 1935; Moore and colleagues, who first described resection and reconstruction of the superior mesenteric vein (SMV) in 1951; and Fortner, who reported his experience with regional pancreatectomy in 1973. Fortner routinely divided the distal splenic vein when performing segmental resection of the SMPV confluence, allowing for a primary end-to-end anastomosis of the SMV and portal vein (PV).1–3 However, the failure of regional pancreatectomy to positively influence survival duration caused most to dismiss venous resection as an ineffective, high-risk, and therefore overaggressive approach to a disease that is often metastatic at diagnosis. Adding to this controversy was the inability of preoperative imag ...
    Annals of Surgical Oncology 12/2014; 22(6). DOI:10.1245/s10434-014-4307-0 · 3.94 Impact Factor
  • Annals of Surgery 01/2015; 261(1):18-20. DOI:10.1097/SLA.0000000000000996 · 7.19 Impact Factor