Greer Julia B, Brand Randall E
Dr. Greer serves as Research Assistant Professor in the Division of Gastroenterology, Hepatology, and Nutrition at the University of Pittsburgh Medical Center where Dr. Brand is Visiting Professor of Medicine. Dr. Brand serves as Academic Director of Shadyside Hospital and Director of the GI Malignancy Early Detection, Screening, and Prevention Program at the University of Pittsburgh and the University of Pittsburgh Medical Center.
Gastroenterol Hepatol (N Y). 2007 Dec;3(12):929-38.
Despite improvements in the clinical and surgical management of pancreatic cancer, limited strides have been made in the early detection of this highly lethal malignancy. The majority of localized pancreatic tumors are asymptomatic, and the recognized presenting symptoms of pancreatic adenocarcinoma are often vague and heterogeneous in nature. These factors, coupled with the lack of a sensitive and noninvasive screening method, have made population-based screening for pancreatic cancer impossible. Nevertheless, at least two large institutions have performed multimodality-screening protocols for individuals with high risk of pancreatic cancer based on genetic predisposition and strong family history. Abnormalities noted during these screening protocols prompted further investigation or surgery that resulted in the discovery of benign, potentially malignant, and malignant pancreatic lesions. In addition to ductal epithelial pancreatic intraepithelial neoplasia, greater sensitivity has recently been achieved in the identification and characterization of precancerous mucinous pancreatic tumors. Advancements in proteomics and DNA microarray technology may confirm serum-based biomarkers that could be incorporated into future screening algorithms for pancreatic cancer.
尽管胰腺癌的临床和外科治疗有所改善，但在这种高度致命的恶性肿瘤的早期检测方面进展有限。大多数局限性胰腺肿瘤无症状，而胰腺癌公认的症状往往性质模糊且多样。这些因素，再加上缺乏敏感且无创的筛查方法，使得基于人群的胰腺癌筛查无法实现。然而，至少有两家大型机构针对具有遗传易感性和强烈家族史的胰腺癌高危个体实施了多模态筛查方案。在这些筛查方案中发现的异常情况促使进一步检查或手术，从而发现了良性、潜在恶性和恶性胰腺病变。除了导管上皮胰腺上皮内瘤变外，最近在癌前黏液性胰腺肿瘤的识别和特征描述方面也获得了更高的灵敏度。蛋白质组学和DNA微阵列技术的进步可能会证实基于血清的生物标志物，这些生物标志物可纳入未来的胰腺癌筛查算法中。
