Pancreatic adenocarcinoma – early symptoms and screening

Czech version

Authors: Bohuš Bunganič; Přemysl Frič; Miroslav Zavoral
Authors‘ workplace: Interní klinika 1. LF UK a ÚVN, Praha
Published in: Čas. Lék. čes. 2014; 153: 267-270
Category: Review Article

Overview

Pancreatic adenocarcinoma is a dismal disease with a very serious prognosis and a very low 5-year survival. Local symptoms are present at a late stage of the disease and in the majority of cases do not enable radical surgery. Intervention is possible only in locally restricted tumor and remains the only chance of significant survival. At present, two early symptoms of this growth are known. They include impaired glucose tolerance or diabetes similar to but not identical with diabetes type 2, and a decrease of the body mass. They precede by a period of 2–3 years local symptoms that are late and cause the bad prognosis. The earlier diagnosis of pancreatic adenocarcinoma represents an urgent and serious task. The project of a screening program based on the use of the early symptoms may move the diagnosis of pancreatic adenocarcinoma to the earlier stage of the disease. The key-players for the most important first step of this program are general practitioners and ambulatory diabetologists.

Keywords:
pancreatic adenocarcinoma – early symptoms – glucose homeostasis – body mass – screening program

Sources

1. Schwarts SS, Zeidler A, Moossa AR, et al. A prospective study of glucose tolerance, insulin, C-peptide, and glucagon responses in patients with pancreatic carcinoma. Am J Dig Dis 1978; 23: 1107–1014.

2. Cersosimo E, Pisters PW, Pesola G, et al. Insulin secretion and action in patients with pancreatic cancer. Cancer 1991; 67: 486–493.

3. Permert J, Ihse I, Jorfeldt L, et al. Improved glucose metabolism after subtotal pancreatectomy for pancreatic cancer. Br J Surg 1993; 80: 1047–1050.

4. Permert J, Adrian TE, Jacobsson P, et al. Is profound peripheral insulin resistance in patients with pancreatic cancer caused by a tumor associated factor? Am J Surg 1993; 165: 61–66.

5. Gullo L, Pezilli R, Morselli-Labate AM, et al. Diabetes and the risk of pancreatic cancer. N Engl J Med 1994; 331: 81–84.

6. Everhart J, Wright D. Diabetes mellitus as a risk factor for pancreatic cancer. A meta-analysis. JAMA 1995; 273: 1605–1609.

7. Huxley R, Ansary-Moghaddam A, Berrington de González, et al. Type II diabetes in pancreatic cancer: a meta-analysis of 36 studies. Brit J Cancer 2005; 92: 2076–2083.

8. Chari ST, Leibson CL, Rabe KG, et al. Probability of pancreatic cancer following diabetes: A population based study. Gastroenterology 2005; 129: 504–511.

9. Pannala R, Basu A, Petersen GM, et al. New-onset diabetes: a potential clue to the early diagnosis of pancreatic cancer. Lancet Oncology 2009; 10: 88–95.

10. Chari ST, Leibson CL, Rabe KG, et al. Pancreatic cancer-associated diabetes mellitus: prevalence and temporal association with diagnosis of cancer. Gastroenterology 2008; 134: 95–101.

11. Pannala R, Leibson CL, Rabe KB, et al. Temporal association of changes in fasting glucose and body mass index with diagnosis of pancreatic cancer. Am J Gastroenterol 2009; 104: 2318–2325.

12. Chari ST, Zapiach M, Yadav D, et al. Beta-cell function and insulin resistance evaluated by HOMA in pancreatic cancer subjects with varying degrees of glucose intolerance. Pancreatology 2005; 5: 229–233.

13. Aggarwal G, Kamada P, Chari ST. Prevalence of diabetes mellitus in pancreatic cancer compared to common cancers. Pancreas 2013; 42: 198–201.

14. Li C, Balluz LS, Ford ES, et al. Association between diagnosed diabetes and self-reported cancer among US. adults: Findings from the 2009 Behavorial Risk Factor Surveillance system. Diabetes Care 2011; 34: 1365–1368.

15. Aggarwal G, Rabe KG, Petersen GM, et al. New-onset diabetes in pancreatic cancer: a study in the primary care setting. Pancreatology 2012; 12: 156: 161.

16. Li W, Yuan Y, Huang L, et al. Metformin alters expression profiles of microRNAs in human pancreatic cancer cells. Diabetes Res Clin Pract 2012; 96: 187–195.

17. Aggarwal G, Ramachandran V, Javeed N, et al. Adrenomedullin is up-regulated in patients with pancreatic cancer and causes insulin resistance in β cells and mice. Gastroenterology 2012; 143: 1510–1517.

18. Sah RP, Nagpal SJ, Mukhopadhyay, et al. New insights into pancreatic cancer-induced paraneoplastic diabetes. Nat Rev Gastroenterol Hepatol 2013; 10: 423–433.

19. Li D, Morris JS, Liu J, et al. Body mass index, age of onset, and survival in patients with pancreatic cancer. JAMA 2009; 301: 2553–2562.

20. Hart PA, Kamada P, Rabe KG, et al. Wight loss precedes cancer-specific symptoms in pancreatic cancer-associated diabetes mellitus. Pancreas 2011; 40: 768–772.

21. Chari ST, Klee GG, Miller LJ, et al. Islet amyloid polypeptide is not a satisfactory marker for detecting pancreatic cancer. Gastroenterology 2001; 121: 640–645.

22. Basso D, Greco E, Fogar P, et al. Pancreatic cancer – derived S-100A8 N-terminal peptide: a diabetes cause? Clin Chim Acta 2006; 372: 120–128.

23. Pfeffer F, Koczan D, Adam U, et al. Expression of connexin26 in islets of Langerhans is associated with impaired glucose tolerance in patients with pancreatic adenocarcinoma. Pancreas 2004; 29: 284–290.

24. Nakamori S, Ichikawa O, Ogihashi H, et al. Increased blood proinsulin and decreased C-peptide levels in patients with pancreatic cancer. Hepatogastroenterology 1999; 46: 16–24.

25. Mäkimatilla S, Hietaniemi K, Timonen T, et al. In vivo glucose stimulated amylin secretion is increased in nondiabetic patients with pancreatic cancer. .Metabolism 2001; 50: 1036–1042.

26. Kolb A, Rieder S, Born D, et al. Glucagon/insulin ratio as a potential biomarker for pancreatic cancer in patients with new-onset diabetes mellitus. Cancer Biol Ther 2009; 8: 1527–1533.

27. Krechler T, Zeman M, Vecka M, et al. Leptin and adiponectin in pancreatic cancer: connection with diabetes mellitus. Neoplasma 2011; 58: 58–64.

28. Frič P, Zavoral M. Early diagnosis of pancreatic adenocarcinoma. Role of stroma, surface proteases, and glucose-homeostatic agents. Pancreas 2012; 41: 663–670.

29. Poruk KE, Firpo MA, Adler DG, et al. Screening for pancreatic cancer-why, how, and who? Annal Surg 2013; 257: 17–26.

30. Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006; 6: 17–32.

31. Lee JH, Kim SA, Park HY, et al. New-onset diabetes patients need pancreatic cancer screening? J Clin Gastroenterol 2012; 46: e58–61.

Labels

Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management

Overweight, obesity and underweight prevalence in 7-year-old children in the Czech Republic since 1951

Is obesity an adverse prognostic factor for pulmonary manifestations of influenza? Lesson from complicated disease course H1N1

Article was published in

Journal of Czech Physicians

2014 Issue 6

Download issue PDF