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【medical-news】胰腺癌遗传高危人群的监控
"For these reasons, detecting abnormalities at the pre-cancerous stage has great potential to save lives," said Teresa A. Brentnall, MD, associate professor of medicine at the division of gastroenterology at the University of Washington, Seattle.
Investigators studied 100 patients for 10 years in a specialized program. The patients were selected from two groups: patients with two or more family members with pancreatic cancer, at least one of whom was a first-degree relative; and patients with a known gene for a lifetime risk of pancreatic cancer of 15 percent or more.
Patients were examined using endoscopic ultrasound (EUS), a combined procedure using endoscopy and ultrasound to obtain information and images about the digestive tract, as well as surrounding organs and tissue. EUS can show whether the pancreas appears to be unhealthy, but it doesn't show exactly what the problem may be or how severe it may be.
Patients whose EUS detected problems were given a choice: either do nothing and let the cancer form - a risky option, since cells can go from normal to cancerous in one year - or remove the pancreas, which causes diabetes. "The stakes are very high. The pancreatic cancer survival rate is only about five years. There is also the risk that the patient could suffer complications from diabetes which could be fatal," said Dr. Brentnall.
Of the 100 patients, 52 had an abnormal EUS on initial exam; three of them abstained from alcohol and their status returned to normal. Also, 10 of the 48 who initially had a normal EUS developed new abnormal EUS changes under surveillance. Two patients who went on to have cancer developed new masses at one and four years after surveillance; the masses developed within one year of an abnormal EUS with no masses. Finally, none of the patients with advanced pancreatic pre-cancer who had surgery developed pancreatic cancer during an average follow-up of seven years.
The majority of patients in the study did not opt for surgery and instead were monitored as part of a rigorous surveillance program in which their progress was closely tracked. Physicians worked closely with patients to determine their prognosis and make tailored recommendations. "EUS can assist in the detection of pancreatic neoplasia when performed in a specialized center and can lead to the detection of curable pancreatic pre-cancer," said Dr. Brentnall.
She added that the program can only exist successfully with a staff that is specifically designated as part of a surveillance team, and that the endoscopic training - and practice - is rigorous, so many hospitals in different areas of the country would not be likely to have such a program. Another difficulty is that experts tend to disagree on what EUS reveals; images tend to be more suggestive and less definitive, which also complicates detection and therefore treatment. [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-03-01 17:14
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