Hepato-pancreato-biliary Programs
Liver metastases from colorectal cancer multidisciplinary care
- Surgical resection
- Chemotherapy
- Hepatic artery infusion
- Ablation
Liver and Biliary cancer multidisciplinary care
Gastroenteropancreatic neuroendocrine multidisciplinary care
Pancreatic cancer multidisciplinary care
Pancreatic cancer is a complex disease which requires expertise from various disciplines to formulate an individualized treatment plan
Pancreatic cyst multidisciplinary care
Who is likely to benefit from the service?
Patients with newly diagnosed pancreatic cysts.
Pancreatic cysts are common and a small number of which are premalignant or malignant upon presentation. There are different types of pre-malignant cysts and each cyst is associated with unique biology and a different risk of malignancy. Patient with pancreatic cysts are categorized into low, intermediate or high risk malignant potential. Treatment options depend on category of risk, and involve either surveillance or surgical resection.
What is the management of pancreatic cysts?
Management is individualized to the patient based on patient age, patient fitness, location of cyst, and type of cyst. Most patients undergo surveillance imaging with either EUS or MRI, and a small fraction of patients will proceed with pancreatic surgery.
Surveillance imaging
- MRI
- EUS, which offers fine needle aspiration of cyst fluid, in addition to biopsy of cyst wall to determine risk category of cyst. Mutational analysis is also carried out on cyst fluid aspirate to guide the physician with the best treatment option.
Surgical resection
Pancreatic surgery involves removing part or all of the pancreas in patients with high risk for malignancy in order to prevent pancreatic cancer.
High-risk pancreatic cancer screening program
What high risk groups should be considered for pancreas cancer screening?
Patients with a strong family history of pancreatic cancer
Familial pancreatic cancer is defined as a kindred with pancreas cancer occurring in 2 or more first degree relatives who do not meet the criteria for other hereditary cancer syndromes
- Patients with hereditary cancer syndromes associated with high risk of pancreatic cancer:
Peutz-Jeghers syndrome, caused by mutation in STK11 gene. This syndrome is also linked with polyps in the digestive tract and several other cancers such as stomach, small intestine, colon, breast and reproductive organs. Screening should start at age 35
- Familial atypical multiple mole melanoma (FAMMM) syndrome, caused by mutation in CDKN2A gene. This syndrome is associated with skin and eye melanomas. Screening should start at age 40
- Hereditary pancreatitis, caused by mutation in the PRSS1 gene. This condition is associated with recurrent pancreatitis. Screening should start at age 40.
- Lynch syndrome (Hereditary Non-Polyposis Colon Cancer/HNPCC), caused by mutations in MLH1, MLH2, MSH6 and PMS2. This syndrome is associated with colorectal cancer, endometrial cancer, gastric, urothelial, brain, cutaneous, and other types of cancers.
- Hereditary breast and ovarian cancer syndrome, caused by mutations in BRCA1 or BRCA2. This syndrome is associated with breast cancer, ovarian cancer, prostate cancer.
- Patients with pancreatic cystic lesions
- Intraductal papillary mucinous neoplasms (IPMN) are cystic neoplasms of the pancreas that grow within the pancreatic ducts and produce mucin. These lesions can progress into pancreatic cancer.
- Mucinous cystic neoplasms(MCN) are cystic neoplasms of the pancreas and occur almost exclusively in the pancreatic body and tail of middle-aged women. These lesions can progress into pancreatic cancer.
- Nongenetic risk factors for development of pancreatic cancer are
- Chronic pancreatitis
- Smoking
- Obesity
- DM
What modalities should be utilized for pancreas cancer screening?
MRI and EUS are currently the preferred modalities for pancreas cancer screening due to their high sensitivity for the detection of pancreas lesions and low risk profile. Lesion sampling can be achieved with EUS-guided fine needle aspiration.
The Pancreatic Cancer Early Detection (PRECEDE) Consortium is an international, multi-institutional collaboration focused on improving early detection and prevention of pancreatic cancer, particularly for individuals with a family history or genetic predisposition. The University of Arizona is a participating site within the PRECEDE Consortium.