Últimos avances sobre los tumores pancreáticos | Gastroenterología y Hepatología

Article information

Resumen

El cáncer de páncreas (CP) continúa siendo una entidad de pésimo pronóstico. Aparecen estudios epidemiológicos que sugieren nuevos factores protectores de la enfermedad, como el consumo de aspirina y ácido oleico. La ultrasonografía endoscópica (USE) continúa siendo el pilar fundamental diagnóstico, surgiendo avances asociados a ella, como el empleo de la elastografía cuantitativa (coeficiente de elasticidad o strain ratio y el análisis por histograma de colores) y los contrastes por vía intravenosa, así como el desarrollo de nuevas agujas para obtención de material histológico (pro-core), que intervienen en el diagnóstico diferencial. Como novedad para años venideros surge la endomicroscopía confocal para el diagnóstico del CP y de los tumores quísticos, utilizada mediante una sonda a través de la aguja de 19G de ecoendoscopia. En el campo terapéutico aparecen estudios que evalúan la seguridad y la eficacia de la administración intratumoral de gemcitabina mediante USE-punción inyección. En relación con los tumores quísticos, el tumor mucinoso papilar intraductal continúa siendo el más estudiado, apareciendo estudios que evalúan determinados criterios de trasformación maligna y analizan la historia natural de esta neoplasia.

Palabras clave:

Cáncer de páncreas

Tumor mucinoso papilar intraductal

Tumores quísticos pancreáticos

Ultrasonografía endoscópica

Abstract

Pancreatic cancer (PC) continues to have a poor prognosis. New epidemiological trials have suggested that there may be protective factors, such as aspirin or oleic acid intake. The main diagnostic tool for PC is endoscopic ultrasound (EUS), and new EUSrelated technologies have appeared, such as quantitative elastography (strain ratio and hue histogram analysis), intravenous contrasts, and the new procore needles to help in the differential diagnosis with other diseases (mainly chronic pancreatitis). In the next few years, intratumoral confocal endomicroscopy will be used for the diagnosis of PC and cystic tumors, by inserting a miniprobe inside the 19G needle of the echoendoscope.

Notable therapeutic developments are studies on the safety, feasibility and accuracy of intratumoral gemcitabine administration by EUS-fine needle injection in the treatment of locally advanced PC. In the treatment of cystic tumors of the pancreas, mainly intraductal papillary mucinous neoplasms (IPMN), most studies aim to optimize follow up by assessing predictive factors of malignant transformation and evaluating the natural history of this neoplasm.

Keywords:

Pancreatic cancer

Intraductal papillary mucinous neoplasm

Pancreatic cystic tumors

Endoscopic ultrasound

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Bibliografía

[1.]

J.E. Domínguez Muñoz.

Clinical pancreatology for practising gastroenterologist and surgeons.

Blackwell Publishing, (2005),

[2.]

T.L. Fitzgerald, Z.J. Hickner, M. Schmitz, E.J. Kort.

Camping incidence of pancreatic neoplasms: a 16-year review of statewide tumour registry.

Pancreas, 37 (2008), pp. 134-138

http://dx.doi.org/10.1097/MPA.0b013e318163a329 | Medline

[3.]

E. Yekebas, D. Bogoevski, M. Bubenheim, B. Link, J. Kaifi, R. Wachowiak, et al.

Strong prognostic value of nodal and bone marrow micro-involvement in patients with pancreatic ductal carcinoma receiving no adjuvant chemotherapy.

Worl J Gastroenterol, 12 (2006), pp. 6515-6521

[4.]

I. Vogel, W. Kruger, J. Marxen, E. Soeth, H. Kalthoff, D. Henne-Bruns, et al.

Disseminated tumor cells in pancreatic cancer patients detected by inmunocytology: a new prognostic factor.

Clin Cancer Res, 5 (1999), pp. 593-599

Medline

[5.]

A.B. Lowenfels, P. Maissoneuve.

Epidemiology and risk factors for pancreatic cancer.

Best Pract Res Clin Gastroenterol, 20 (2006), pp. 197-209

http://dx.doi.org/10.1016/j.bpg.2005.10.001 | Medline

[6.]

Y. Lin, A. Tamakoshi, T. Kawamura, Y. Inaba, S. Kikuchi, Y. Motohashi, et al.

Risk of pancreatic cancer in relation to alcohol drinking, coffee consumption and medical history: findings from the Japan collaborative cohort study for evaluation of cancer risk.

Int J Cancer, 99 (2002), pp. 742-746

http://dx.doi.org/10.1002/ijc.10402 | Medline

[7.]

R.Z. Stolzenberg-Solomon, P. Pietinen, P.R. Taylor, J. Virtamo, Albanes.

A prospective study of medical conditions, anthropometry, physical activity and pancreatic cancer in male smokers.

Cancer Causes Control, 13 (2002), pp. 417-426

Medline

[8.]

M. Pugh, M. Little, F. Carey, R. Robinson, A. Clark, M. Metcalle, et al.

Aspirin, NSAID, calcium-channel blockers and statins in the aetiology of pancreatic cancer: preliminary results from a case-control study in two centres in the UK.

Gastroenterology, 140 (2011), pp. AB575

[9.]

Banim P, Luben R, Mctaggart A, Khaw K, wareham N, Hart A. Do oleic acid and N-3 fatty acids prevent pancreatic cancer? Data from a UK prospective cohort study using 7-day food diaries. AB1071.

[10.]

Banim P, Luben R, Khaw K, Wareham A, Hart A. Physical activity and the risk of developing pancreatic cancer-data from a UK prospective study (EIPC-Norfolk). AB 1076.

[11.]

J. Iglesias García, J. Laiño Noia, J.E. Domínguez Muñoz.

What is the best method to quantify tissue stiffness by Endoscopic Ultrasound (EUS) Elastography: strain ratio or Hue histogram analysis?.

Gastroenterology, 140 (2011), pp. AB1124

[12.]

J. Iglesias-García, J. Larino-Noia, I. Abdulkader, J. Forteza, J.E. Domínguez-Muñoz.

Quantitative endoscopic ultrasound elastography: an accurate method for the differentiation of solid pancreatic masses.

Gastroenterology, 139 (2010), pp. 1172-1180

http://dx.doi.org/10.1053/j.gastro.2010.06.059 | Medline

[13.]

A. Săftoiu, P. Vilmann, F. Gorunescu, D.I. Gheonea, M. Gorunescu, et al.

Neural network analysis of dynamic sequences of EUS elastography used for the differential diagnosis of chronic pancreatitis and pancreatic cancer.

Gastrointest Endosc, 68 (2008), pp. 1086-1094

http://dx.doi.org/10.1016/j.gie.2008.04.031 | Medline

[14.]

R. Gincul, L. Palazzo, B. Pujol, L. Tubach, C. Lefort, M. Palazzo, et al.

Contrast-enhanced harmonic ultrasound (CEH-EUS) in diagnosis of pancreatic adenocarcinoma: results of the first multicenter prospective study with intra and interobserver concordances evaluation.

Gastroenterology, 140 (2011), pp. AB112

[15.]

M. Giovanninni, M. Monges, F. Caillol, E. Bories, C. Pesenti.

Feasibility of intratumoral confocal microscopy under EUS guidance (EUS-CM).

Gastroenterology, 140 (2011), pp. AB906-AB907

[16.]

M. Giovanninni, M. Monges, J. Iglesias-García, A. Largi, I. Abdulkader, J. Poley, et al.

Prospective multicenter evaluation of a novel 22G Echo-tip procore histology EUS-needle in patients with a solid pancreatic mass.

Gastroenterology, 140 (2011), pp. AB194

[17.]

J. Iglesias García, I. Abdulkader, R. Souto, J. Lariño-Noia, J. Forteza, J.E. Domínguez Muñoz.

Procure histology needles 819-gauge and 22 gauge) vs standard cytology needles (22-gauge and 25-Gauge) in the differential diagnosis of solid pancreatic tumours.

Gastroenterology, 140 (2011), pp. AB645

[18.]

R. Battish, J. Wong, J. Farrell.

Initial experience with a novel endoscopic ultrasound guided biopsy (EUSCB) core needle compared with standard fine needle aspiration (EUSFNA). A formal prospective tandem comparative study in pancreatic masses.

Gastroenterology, 140 (2011), pp. AB645

[19.]

N. Valsangkar, D. Bush, J. Michaelson, C. Fernández del Castillo, A. Warshaw, S. Thayer.

Prognostic value of lymph node ratio increases with number of lymph nodes examined: a concomitant review of SEER and a single institution's patients.

Gastroenterology, 140 (2011), pp. AB707-AB708

[20.]

H. Riediger, T. Keck, U. Wellner, A. Hausen, U. Adam, U. Hopt, et al.

The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer.

J Gastrointest Surg, 13 (2009), pp. 1337-1344

[21.]

K. Shimada, S. Nara, M. Esaki, Y. Sakamoto, T. Kosuge, N. Hiraoka.

Intrapancreatic nerve invasion as a predictor for recurrence after pancreaticoduodenectomy in patients with invasive ductal carcinoma of the pancreas.

Gastroenterology, 140 (2001), pp. AB705

[22.]

J. Farrel, J. Wong, T. Donahue, J. Rao.

Development and validation of an EUS-FNA-based predictive marker of gemcitabine response in pancreatic cancer.

Gastroenterology, 140 (2011), pp. AB647

[23.]

J.J. Farrell, H. Elsaleh, M. Garcia, R. Lai, A. Ammar, W.F. Regine, et al.

Human equilibrative nucleoside transporter 1 levels predict response to gemcitabine in patients with pancreatic cancer.

Gastroenterology, 136 (2009), pp. 187-195

http://dx.doi.org/10.1053/j.gastro.2008.09.067 | Medline

[24.]

E. Witkowski, J. Smith, E. Ragulin, S. Chau, A. Shimul, J. Tseng.

Is it worth looking? Abdominal imaging after pancreatic resection: a national study.

Gastroenterology, 140 (2011), pp. AB237

[25.]

A. Sofuni, M. Moriyasu, T. Sano, K. Yamada, F. Itokawa, T. Tsuchiya, et al.

Evaluation of safety trial of high intensity focused ultrasound tharapy for pancreatic cancer.

Gastroenterology, 140 (2011), pp. AB566

[26.]

M. Levy, S. Alberts, S. Chari, M. Farnell, M. Haddock, M. Kendrick, et al.

EUS-guided intratumoral gemcitabine therapy for locally advanced and metastasic pancreatic cancer.

Gastroenterology, 140 (2011), pp. AB174-AB175

[27.]

C. Hwang, S. Kumar, T. Yab, W. Taylor, J. Kisiel, L. Aimee, et al.

Noninvasive detection of intraductal papillary mucinous neoplasms (IPMN) and early stage cancer of the pancreas with stool DNA testing.

Gastroenterology, 140 (2011), pp. AB1038

[28.]

L. Lee, M. Croak, K. Repas, B. Wu.

Clinical utility of pancreatic cyst fluid DNA mutation analysis for detecting malignancy: a retrospective cohort study.

Gastroenterology, 140 (2011), pp. AB1074-AB1075

[29.]

A. Meining, S. Lo, L. Jamil, M. Wallace, R. Aslanian, U. Siddiqui, et al.

In vivo needle-based confocal laser endomicroscopy (nCLE) study in the pancreas with endosonography of cystic tumours (INSPECT): Interim results from an international prospective multicentric study.

Gastroenterology, 140 (2011), pp. AB286

[30.]

N. Zhong, M. Topazian, M. Canto, J. Clain, J. Deutsc, J. De Witt, et al.

Specific EUS imaging criteria distinguish mucus from mural nodules in pancreatic cystic neoplasms.

Gastroenterology, 140 (2011), pp. AB643-AB644

[31.]

C. Cauley, J. Waters, R. Dumas, J. Meyer, J. De Witt, K. Lilemoe, et al.

Outcomes of primary surveillance for intraductal papillary mucinous neoplasms.

Gastroenterology, 140 (2011), pp. AB237

[32.]

L. Khanna, S. Amin, S. Kumar, A. Lucas, L. Pursell, J. Chiabot, et al.

Timeline of progression from adenoma to invasive carcinoma in intraductal papillary mucinous neoplasms.

Gastroenterology, 140 (2011), pp. AB1039

[33.]

Othman M, Patel M, Dabizzi E, Bowers S, Asbun H, Wallace M, et al. Intracystic CEA and long term follow-up of intraductal papillary mucinous neoplasm of the pancreas (IPMN).

[34.]

C. Loeser, C. Lawrence, R. Hawes, B. Hoffman, J. Romagnuolo.

Predicting progression of side branch (SB) intraductal papillary mucinous neoplasm (IPMN).

Gastroenterology, 140 (2011), pp. AB1076

[35.]

W. Khannousi, M. Vullierme, F. Maire, V. Rebours, A. Sauvanet, S. Dokmak, et al.

Branch duct intraductal papillary neoplasm (BDIPMN): risk of malignancy still present after 5 years of followup.

Gastroenterology, 140 (2011), pp. AB1074