Pancreatic cancer (PC) behaves very differently in comparison with other malignancies. Its incidence has been increasing continuously; mortality has not decreased, the diagnosis is frequently late, radical surgery is performed only in 15-20% of patients, and chemotherapy is only palliative. PC occurs in three different forms. Sporadic PC accounts for 90% of all PCs. Its most frequent form is the pancreatic ductal adenocarcinoma. The remaining 10% constitute two minority groups: familial PC (7%) and PC as a manifestation of a genetic cancer syndrome (3%). PCs are preceded by a precancerous lesion (precursor). At present, six different precursors are known. They have different histomorphological characteristics and malignant potential. The recognition and correct interpretation of individual precursors influences adequate clinical decision-making. The publication surveys the present knowledge of individual precursors and their role in the early pancreatic carcinogenesis.
- MeSH
- časná detekce nádoru MeSH
- duktální karcinom pankreatu genetika metabolismus patologie terapie MeSH
- epigeneze genetická MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádorová transformace buněk genetika metabolismus patologie MeSH
- nádorové biomarkery genetika metabolismus MeSH
- nádory slinivky břišní genetika metabolismus patologie terapie MeSH
- prekancerózy genetika metabolismus patologie terapie MeSH
- prognóza MeSH
- regulace genové exprese u nádorů MeSH
- rizikové faktory MeSH
- senioři MeSH
- signální transdukce MeSH
- zvířata MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
- Klíčová slova
- endoskopická ultrasonografie,
- MeSH
- diabetes mellitus MeSH
- diagnostické techniky molekulární MeSH
- diagnostické zobrazování metody MeSH
- lidé MeSH
- nádory slinivky břišní * diagnostické zobrazování diagnóza epidemiologie mortalita MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Sporadic pancreatic cancer amounts to ∼90% of all pancreatic cancers. It is a gloomy depressive disease and the most recalcitrant malignancy, with a very low 5-year survival (3-6%). At present, diagnostic methods are commonly applied, as used half a century ago, after the appearance of local and systemic symptoms (abdominal and back pain, cholestasis, painless jaundice, fatigue, anorexia, weight loss, anemia, peripheral phlebitis, and cachexia). Unfortunately, these symptoms are harbingers of an advanced disease. The subsequent imaging methods may offer additional information on the location, size, and morphology of the lesion, but they do not influence the prognosis. Radical surgery may be offered to 15-20% of patients. The relapses after surgery are frequent and chemotherapy may be palliative. Preventive programs represent the only possibility of improvement. We propose the first multistep and multidisciplinary preventive program for early detection of sporadic pancreatic cancer for the differential identification of average-risk patients who probably have the disease from those who do not.
- MeSH
- časná detekce nádoru * MeSH
- časové faktory MeSH
- duktální karcinom pankreatu diagnóza mortalita terapie MeSH
- hodnocení rizik MeSH
- lidé MeSH
- nádory slinivky břišní diagnóza mortalita terapie MeSH
- prediktivní hodnota testů MeSH
- prognóza MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- MeSH
- genetické testování metody MeSH
- intervenční ultrasonografie metody MeSH
- lidé MeSH
- nádorové biomarkery analýza krev MeSH
- nádory slinivky břišní * diagnostické zobrazování genetika klasifikace patologie MeSH
- počítačová rentgenová tomografie metody MeSH
- senzitivita a specificita MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
BACKGROUND: The changes in gastrointestinal hormones associated with pancreatic ductal adenocarcinoma (PDAC) in patients with impaired glucoregulation have yet to be evaluated. The aim of this study was to determine plasma concentrations of selected gastrointestinal hormones in PDAC patients with and without diabetes and to compare them with levels found in Type 2 diabetic patients without cancer. METHODS: In this study we examined plasma concentrations of glucose-dependent insulinotropic peptide (GIP), glucagon-like peptide 1 (GLP-1), pancreatic polypeptide (PP), peptide YY (PYY) and neuropeptide Y (NPY), and cytokines leptin and adiponectin in 94 patients with histologically confirmed PDAC. Thirty-nine patients with Type 2 diabetes without PDAC and 29 healthy individuals with no evidence of acute or chronic diseases were examined as controls. RESULTS: Significantly lower plasma concentrations of GIP were found in PDAC patients with new-onset diabetes/prediabetes (n = 76), or in those with normal glucose regulation (n = 18), compared to patients with Type 2 diabetes without PDAC and controls (15.5 (3.7-64.5) or 6.5 (1.7-24.5) vs. 39.8 (15.1-104.7) and 28.8 (7.4-112.2) ng/L, p < 0.001); the same relationship was observed for PP (38.9 (10.2-147.9) or 28.1 (7.9-100.0) vs 89.1 (38.0-208.9) and 75.8 (30.1-190.6) ng/L, p < 0.01), respectively. The lowest levels of GIP and PP concentrations were found in PDAC patients with new-onset diabetes/prediabetes and weight loss > 2 kg (p < 0.001). CONCLUSIONS: We conclude that GIP and PP plasma concentrations are lower in pancreatic cancer irrespective of the degree of glucose intolerance as compared to Type 2 diabetic patients and healthy controls. In new onset diabetes especially if associated with weight loss, these changes may represent a new clue for the diagnosis of PDAC.
- MeSH
- biologické markery krev MeSH
- diabetes mellitus 2. typu krev komplikace patofyziologie MeSH
- dospělí MeSH
- duktální karcinom pankreatu krev komplikace diagnóza patofyziologie MeSH
- glukagonu podobný peptid 1 krev MeSH
- hmotnostní úbytek * MeSH
- krevní glukóza metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory slinivky břišní krev komplikace diagnóza patofyziologie MeSH
- neuropeptid Y krev MeSH
- pankreatický polypeptid krev MeSH
- peptid YY krev MeSH
- porucha glukózové tolerance krev komplikace patofyziologie MeSH
- senioři MeSH
- studie případů a kontrol MeSH
- žaludeční inhibiční polypeptid krev MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Risk factors (long-term diabetes, obesity) and early symptoms (new-onset diabetes, loss of weight, or persistent low body mass) are the initial symptoms of pancreatic carcinogenesis. They may be influenced by antidiabetic drugs and their correct evaluation is a prerequisite for early diagnosis of pancreatic cancer (PC). We review the risk factors, early symptoms, and the impact of antidiabetic drugs on early pancreatic carcinogenesis. The main source of data was the database Medline/PubMed and abstracts of international congresses (DDW, UEGW). The risk factors and early symptoms are integral components of the familial PC surveillance and sporadic PC screening. Preventive programs should always be include multistep and multidisciplinary procedures. The correct evaluation of antidiabetic drugs and their interactions with other components of pancreatic carcinogenesis may influence the early diagnosis of PC.
- MeSH
- časná detekce nádoru metody MeSH
- hypoglykemika škodlivé účinky MeSH
- komplikace diabetu diagnóza etiologie MeSH
- lidé MeSH
- nádorová transformace buněk účinky léků MeSH
- nádory slinivky břišní diagnóza etiologie MeSH
- obezita komplikace MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
High-resolution imaging methods (HRIMs) and biomarkers present the second step of pancreatic cancer (PC) diagnostics in at-risk individuals. These include patients with positive risk factors, early symptoms, nonresponders to the initial antidiabetic therapy, patients older than 50 years of age with new-onset unstable diabetes requiring insulin as well as patients with long-term insulin-non-dependent diabetes and recent (up to 6 months) failure of antidiabetic therapy. The procedures should be started without delay and the co-operation between the primary and tertiary medical centers is highly desirable. An early indication of HRIMs and biomarkers is a prerequisite for the diagnosis of a resectable PC. This publication reviews the recent contribution of HRIMs and biomarkers toward an early diagnosis of PC.
- MeSH
- adenom diagnostické zobrazování genetika metabolismus MeSH
- biologické markery MeSH
- časná detekce nádoru metody MeSH
- cholangiopankreatografie endoskopická retrográdní MeSH
- duktální karcinom pankreatu diagnostické zobrazování genetika metabolismus MeSH
- elastografie MeSH
- endosonografie MeSH
- karcinom in situ diagnostické zobrazování genetika metabolismus MeSH
- lidé MeSH
- magnetická rezonanční cholangiopankreatografie MeSH
- magnetická rezonanční tomografie MeSH
- mikro RNA genetika MeSH
- multidetektorová počítačová tomografie MeSH
- nádory cystické, mucinózní a serózní diagnostické zobrazování genetika metabolismus MeSH
- nádory slinivky břišní diagnostické zobrazování genetika metabolismus MeSH
- PET/CT MeSH
- plektin metabolismus MeSH
- protilátky metabolismus MeSH
- ultrasonografie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
