Incidence of pancreatic carcinoma in persons with chronic pancreatitis
Authors:
P. Dítě 1; I. Novotný 1; M. Přecechtělová 1; M. Růžička 2; A. Žáková 1; J. Trna 1; M. Hermannová 3; A. Ševčíková 1
Authors‘ workplace:
Interní hepatogastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jan Lata, CSc.
1; Departement of Surgery, Sheik Kalifa Medical City, Abu Dhabi, UAE
2; I. patologicko‑anatomický ústav Lékařské fakulty MU a FN u sv. Anny Brno, přednostka doc. MUDr. Markéta Hermanová, Ph. D.
3
Published in:
Vnitř Lék 2009; 55(1): 18-21
Category:
Original Contributions
Overview
Introduction:
Pancreatic carcinoma is one of the diseases which mostly fail to be diagnosed on a timely basis, and there is no way to effectively screen patients for pancreatic carcinoma either. An option for the diagnosis of the “early glandular carcinoma” therefore resides in identification and systematic screening of patients with risk of pancreatic carcinoma.
Method:
We monitored 223 patients with chronic pancreatitis on a systematic basis from 1992 to 2005. During this 14-year period, we monitored the number of cigarettes smoked per year in addition to standard parametres measured by biochemical methods, endosonography, CT and ERCP exams, and assigned the alcoholic form of chronic pancreatitis to patients consuming more than 80 g of alcohol per day on a systematic basis for more than 5 years in the case of men, and 50 g of alcohol per day in the case of women, and classed the patients according the TIGARO classification.
Results:
Alcoholic etiology was proven in 73.1% of the examined patients, chronic obstructive form of pancreatitis was diagnosed in 21.5% of patients, and only 5.4% of patients were classified into the idiopathic pancreatitis group. Pancreatic carcinoma in the region of chronic pancreatitis was found in 13 patients (5.8%); stomach carcinoma was diagnosed in 3 patients with chronic pancreatitis, and oesophageal carcinoma in 1 patient of the total of patients monitored. Malignant pancreatic disease was diagnosed primarily in patients with alcoholic pancreatitis (4.5%). During the period of 14 years, 11 patients died, 8 of the deaths being associated with pancreatic carcinoma.
Conclusion:
Both pancreatic and extrapancreatic carcinoma in gastrointestinal location is a serious complication of protracted chronic, non‑hereditary pancreatitis. Systematic identification and treatment of patients with chronic pancreatitis is therefore necessary for timely diagnosis of gastrointestinal and pancreatic malignancies.
Key words:
chronic pancreatitis – pancreatic carcinoma
Sources
1. Andrea-Sandberg A, Al Sharaf K, Halfstrom A. Chronic pancreatitis as a precancerous disease. In: Dervenis VG. Advances in pancreatic disease. G. Thieme Verlag 1996.
2. Deixonne B, Pingnodel C, Chazelet C et al. Small carcinomas of the pancreas with associated chronic pancreatitis. Two case reports. Eur J Surg Oncol 1989; 15: 265–270.
3. Dítě P, Starý K, Novotný J et al. The incidence of chronic pancreatitis in Czech Republic. Europ J Gastroent Hepatol 2001; 13: 749–750.
4. Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 2001; 120: 682–707.
5. Ekbom A, Mc Laughlin JK, Karlsson BM et al. Pancreatitis and pancreatic cancer: A population‑based study. J Natl Cancer Res Indy 1994; 86: 625–627.
6. Evans JD, Morton DG, Neoptolemos JP. Chronic pancreatitis and pancreatic carcinoma. Postgrad Med J 1997; 73: 543–548.
7. Finch MD, Howes N, Ellis I et al. Hereditary pancreatitis and familial pancreatic cancer. Digestion 1997; 58: 564–569.
8. Gold EB, Cameron JL. Chronic pancreatitis and pancratic cancer. N Engl J Med 1993; 828: 1485–1486.
9. Kalopathaki V, Tzonou A, Hsieh CS et al. Tabacco, ethanol, coffee, pancreatitis, diabetes mellitus and cholelithiasis as risk factor for pancreatic carcinoma. Cancer Causes Control 1993; 4: 375–382.
10. Kamisawa T, Tu Y, Egawa T et al. The incidence of pancreatic and extrapancreatic cancers in Japanese patients with chronic pancreatitis. Hepato-gastroenterology 2007; 54: 1579–1581.
11. Karlson BM, Elbolm A, Josefsson S et al. The risk of pancreatic cancer. Following pancreatitis: an association due to confounding? Gastroenterology 1997; 113: 587–592.
12. Löwenfels AB, Maisonneuve P, Cavallini G et al. Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med 1993; 828: 1433–1437.
13. Löwenfels AB, Maisonneuve P, Di Magno EP et al. Hereditary pancreatitis and the risk of pancreatic cancer. J Nat Cancer Indy 1997; 89: 442–446.
14. Löwenfels AB, Maisonneuve P, Cavallini G et al. Prognosis of chronic pancreatitis: an international multicenter study. Am J Gastroenterol 1994; 89: 1467–1471.
15. Malka D, Hammel P, Maire F et al. Risk of pancreatic adenocarcinoma in chronic pancreatitis. GUT 2002; 51: 849–852.
16. Thuluvath PJ, Imperio D, Nair S et al. Chronic pancreatitis. Long‑term pain relief with or without surgery, cancer risk, and mortality. J Clin Gastroenterol 2003; 36: 159–165.
17. Rocca G, Gaia E, Iuliano R et al. Increased incidence of cancer in chronic pancreatitis. J Clin Gastroenterol 1987; 9: 175–179.
18. Hansen TH, Larsen M, Christensen E et al. Chronic pancreatitis and extrapancreatic cancer. A retrospective study among 181 patients with chronic pancreatitis. Int J Pancreatol 1995; 18: 235–239.
19. Ammann RW, Knoblauch M, Mohr P et al. High incidence of extrapancreatic carcinoma in chronic pancreatitis. Scand J Gastroenterol 1980; 15: 393–399.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2009 Issue 1
Most read in this issue
- Adrenal cancer
- Coronary artery ectasia and triple-vessel disease
- Treatment of Waldenström macroglobulinaemia – the experience of one centre
- Cardiovascular rehabilitation today