Treatment Options for Hepatobiliary and Pancreatic Cancer

Division of Medical Oncology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Mayo Clinic Proceedings (Impact Factor: 6.26). 06/2007; 82(5):628-37. DOI: 10.4065/82.5.628
Source: PubMed


Hepatobiliary and pancreatic cancers account for 4% of all cancers in the United States. Traditionally, these cancers have had a high mortality rate and have been poorly responsive to therapy. Because of a growing number of treatment options, patients are now living longer. For hepatocellular carcinoma, a broad number of treatment options are available, including surgery, ablation, embolization, systemic therapy, and liver transplantation. Treatment options for cholangiocarcinoma include surgery, systemic therapy, and liver transplantation. For pancreatic cancer, surgery, radiation, and systemic therapy all have potential roles. This review provides an updated summary of diagnosis and assessment together with treatment options for this group of cancers.

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    • "Primary neoplasms of the biliary system are a heterogeneous group largely comprising of gallbladder carcinoma and cholangiocarcinoma with a few other much rarer tumours. Traditionally these tumours have a high mortality rate, with surgical excision being the mainstay of long-term survival [1]. Advances in surgery have increased the likelihood of achieving local disease control and now limited distant spread may also be considered for resection. "
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    ABSTRACT: To assess the impact on clinical management of introducing (18)F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)-computed tomography (CT) in to the work-up of patients with primary and recurrent biliary malignancy. Consecutive patients with primary biliary tumours undergoing FDG PET-CT at a single large tertiary referral centre between November 2007 and September 2010 were retrospectively analysed. Findings on FDG PET-CT compared with CT/magnetic resonance imaging (MRI) and impact on subsequent patient management were evaluated. Impact was divided into: (1) major-detection of occult disease or characterisation of indeterminate lesion(s) on CT/MRI; (2) minor-confirmation of suspected metastases seen on CT/MRI; (3) no impact. One hundred and eleven patients underwent 118 FDG PET-CT scans, including 30 with suspected gallbladder carcinoma and 81 with cholangiocarcinoma. Eighty-nine scans were performed for initial staging, five for restaging following neoadjuvant chemotherapy and 24 for suspected disease recurrence. In 33 cases (28 %), FDG PET-CT had a major impact on subsequent patient management (39 % gallbladder carcinoma, 26 % intrahepatic cholangiocarcinoma and 21 % extrahepatic cholangiocarcinoma). FDG PET-CT had a minor impact in 20 cases (17 %) and no impact in 65 cases (55 %). By detecting occult metastatic disease and characterising indeterminate lesions, FDG PET-CT can have a major influence on clinical decision-making in primary and recurrent biliary malignancy.
    Insights into Imaging 07/2013; 4(5). DOI:10.1007/s13244-013-0268-2
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    • "We identified additional studies through hand searches of bibliographies from primary studies, review articles and key journals; the search yielded 49 hits [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62]. Only full text papers in the English language were considered; letters, reviews without original data and animal studies, as well as studies treating cancers other than pancreatic adenocarcinoma, were excluded (40 papers in total) [14,15,16,17,18,19,21,22,24,25,26,27,28,29,31,32,33,34,35,37,40,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61]. Of the remaining nine papers, we also excluded four papers because they contained data reported previously [20,23,38,42]. "
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    ABSTRACT: Advanced ductal pancreatic carcinoma (PC) remains a challenge for current surgical and medical approaches. It has recently been claimed that radiofrequency ablation (RFA) may be beneficial for patients with locally advanced or metastatic PC. Using the MEDLINE database, we found seven studies involving 106 patients in which PC was treated using RFA. The PC was mainly located in the pancreatic head (66.9%) with a median size of 4.6 cm. RFA was carried out in 85 patients (80.1%) with locally advanced PC and in 21 (19.9%) with metastatic disease. Palliative surgical procedures were carried out in 41.5% of the patients. The average temperature used was 90 °C (with a temperature range of 30-105 °C) and the ratio between the number of passes of the probe and the size of the tumor in centimeters was 0.5 (range of 0.36-1). The median postoperative morbidity and mortality were 28.3% and 7.5%, respectively; the median survival was 6.5 months (range of 1-33 months). In conclusion, RFA is a feasible technique: however, its safety and long-term results are disappointing; Thus, the RFA procedure should not be recommended in clinical practice for a PC patient.
    Cancers 09/2010; 2(3):1419-1431. DOI:10.3390/cancers2031419
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    ABSTRACT: We have developed a new method to image microscopic structures in living cells using as bright IR radiation source: our high power CW optoparametric oscillator (OPO) with up to 2.7 W output power and a near infrared laser. We present the first results for the chemical microscopy of hepatocytes (liver cells) using a frequency of 2920 cm-1 coinciding with the absorption band of lipids and at 1.5 μm corresponding to the overtones of water. Infrared microscopy allows studying processes of living cells in cases where fluorescence markers are cell damaging, alter the natural function of a protein in a cell or where labeling is impossible. In the infrared spectral range, accessible to our laser systems, substances can be identified according to their specific absorption in the so-called fingerprint region. Moreover, the absorption is directly proportional to the number of molecules, which makes it the appropriate method for quantitative measurements. Our method opens the possibility to investigate rapid changes of chemical behavior and the dynamics of small bio-molecules in living cells. In addition, we demonstrate by using near-field microscopy a spatial resolution of less than 30 nm (≪λ/100) at λ=3222 nm (3104 cm-1).
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