Saturday, April 24, 2010

Intraductal Papillary Mucinous Tumors of the Pancreas -- Conlon 23 (20): 4518 -- Journal of Clinical Oncology

Intraductal papillary mucinous neoplasms (IPMNs) have increasingly occupied the research attention of various medical disciplines because their broad-ranging malignant potential and imaging complexities can present management challenges. Given increasing use of imaging advances and a general heightened
awareness of IPMNs as a diagnostic entity, these tumors have garnered recognition as a promising subset of pancreatic tumors that can be well managed or cured. We review herein the characteristic imaging
Intraductal Papillary Mucinous Tumors of the Pancreas -- Conlon 23 (20): 4518 -- Journal of Clinical Oncology

SpringerLink - Journal Article

Thus, the prime prognostic factor in predicting the survival outcome of IPMNs is resectability, instead of resection itself. Long-term survival could also be expected in resectable IPMNs without resection. No resection for the IPMN may be justified for patients with high surgical risks, especially for those who are asymptomatic and very aged.


SpringerLink - Journal Article

Medline ® Abstracts for References 12-15 of 'Intraductal papillary mucinous neoplasm of the pancreas'

Medline ® Abstracts for References 12-15 of 'Intraductal papillary mucinous neoplasm of the pancreas'

Pancreatic Cancer: Pancreatica - FAQ

Pancreatic Cancer: Pancreatica - FAQ

Whipple: Details, Preparation & Recovery: BCM Dept of Surgery

Whipple: Details, Preparation & Recovery: BCM Dept of Surgery

Whipple: Details, Preparation & Recovery: BCM Dept of Surgery

Whipple: Details, Preparation & Recovery: BCM Dept of Surgery

All What to expect with Whipple Procedure messages

All What to expect with Whipple Procedure messages

What are pancreatic tumors

Intraductal Papillary-Mucinous Neoplasms

They are important to recognize because they represent a potentially curable precursor lesion to invasive pancreatic cancer. The tumors characteristically grow along the ducts of the pancreas that drain the pancreatic fluid into the small intestine.
Microscopically, they usually appear as finger-like projections (papillae) into the duct. These are believed to start as curable precancerous lesions, and some, if untreated may progress to invasive pancreatic cancer. (FAQs on IPMNs)

What are pancreatic tumors

What does pancreas do?

1. Endocrine Pancreas -> secetes hormones to blood
2. Exocrine Pancreas -> digestive enzymes to small intestine
-> pancreat cancer

The normal pancreas is predominately composed of three cell types: islet cells, acini and duct cells.
1. The "islet of Langerhans" cells produce hormones such as insulin.
2. The "acini" produce many of the enzymes, such as lipase, which are needed to digest food in the duodenum.
3. The enzymes produced by the acini are carried to the duodenum by small channels called ducts.

http://pathology.jhu.edu/pancreas/BasicOverview3.php?area=ba

Pancreas - Wikipedia, the free encyclopedia

Thursday, April 22, 2010

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Should We Side Step the Side Branches?

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Should We Side Step the Side Branches?

Intraductal papillary mucinous neoplasms of the pa... [Ann Surg. 2004] - PubMed result

Sohn TA, Yeo CJ, Cameron JL, Hruban RH, Fukushima N, Campbell KA, Lillemoe KD.
Departments of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.

 CONCLUSIONS: IPMNs continue to be recognized with increasing frequency. Five-year survival for those patients following resection of IPMNs with invasive cancer (43%) is improved compared with those patients with resected pancreatic ductal adenocarcinoma in the absence of IPMN (averages 15%-25%). Survival following resection of IPMNs without invasive cancer (regardless of degree of dyplasia) is good, but recurrent disease in the residual pancreas suggests that long-term surveillance is critical. Based on the age at resection data, there appears to be a 5-year lag time from IPMN adenoma (63.2 years) to invasive cancer (68.1 years Intraductal papillary mucinous neoplasms of the pa... [Ann Surg. 2004] - PubMed result

Prognosis of cancer with branch duct type IPMN of the pancreas

In conclusion, to decide on the prognosis for IPMN, the presence of intra- or extra-pancreatic cancer is the main prognostic factor, rather than IPMN per se. Therefore, there is no fixed algorithm regarding the follow-up period or methodology, but in all cases, close follow-up, especially for the development of cancer, is very important.


Prognosis of cancer with branch duct type IPMN of the pancreas

World J Gastroenterol Volume 16(15);  April 21, 2010

World J Gastroenterol Volume 16(15);  April 21, 2010

Increased Risk for Extrapancreatic Neoplasms in Patients With Intraductal Papillary Mucinous Neoplasms

However, the current findings suggest that patients with IPMN should be carefully followed, with focus on the development of colonic polyps, esophageal lesions, or tumors in other gastrointestinal regions, such as the hepatobiliary tree or the stomach.

Abstract

[ CLOSE WINDOW ]
[CLOSE WINDOW]
Authors and Disclosures
Author(s)
Albert B. Lowenfels, MD
Professor of Surgery, Professor of Community Preventive Medicine, New York Medical Center, Valhalla, New York; Emeritus Surgeon, Department of Surgery, Westchester Medical Center, Valhalla, New York

Disclosure: Albert B. Lowenfels, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Solvay Pharmaceuticals, Inc.
Increased Risk for Extrapancreatic Neoplasms in Patients With Intraductal Papillary Mucinous Neoplasms

SpringerLink - Journal Article

Conclusions


Immediate surgery is the most effective, but may be prohibitively expensive. The surveillance strategy is a cost-effective option compared to no surveillance.

SpringerLink - Journal Article

Importance of an Experienced Surgeon

Importance of an Experienced Surgeon

Tuesday, April 20, 2010

What the endoscopist saw -- Murray and Price 74 (887): 1074 -- The British Journal of Radiology

What the endoscopist saw -- Murray and Price 74 (887): 1074 -- The British Journal of Radiology

Operative Therapy for Branch-Duct Intraductal Papillary Mucinous Neoplasms? - Gastroenterology

Operative Therapy for Branch-Duct Intraductal Papillary Mucinous Neoplasms? - Gastroenterology

Basics of Pancreatic Cancer

What is the difference between a main duct and a branch duct intraductal papillary mucinous neoplasm?
Intraductal papillary mucinous neoplasms, as mentioned earlier, form in the main pancreatic duct or in one of the branches off of the main pancreatic duct. Intraductal papillary mucinous neoplasms that arise in the main pancreatic duct are called, as one might expect, “main duct type” IPMNs. Intraductal papillary mucinous neoplasms that arise in one of the branches of the main duct are called “branch duct type” IPMNs. The distinction between main duct type and branch duct type IPMNs is important because several studies have shown that, for each given size, branch duct IPMNs are less aggressive (less likely to have an invasive cancer) than are main duct IPMNs (see references 2,3).

Basics of Pancreatic Cancer