GERD: Everything you need to know about evaluation and treatment of reflux is in this article.
Screening for Pancreatic Cancer
What are the common types of pancreatic cancer?
The most common type of cancer of the pancreas is adenocarcinoma. The hope is to discover lesions that are precursors to the cancer, in hopes to discover lesions before they become aggressive or cancerous. There are precursor lesions to cancer, which can sometimes develop within a cyst. In addition, there are rare types of cancer within the pancreas, such as carcinoid tumors or neuroendocrine tumors.
What are the benefits of a screening program?
Pancreatic cancer when it presents is often advanced. The goal of a screening program is an attempt to detect problems earlier so that the cancer might be found at an earlier stage or before cancer develops. If a cancer is found earlier, there would be more options available for treatment and possibly cure.
What are methods to screen for pancreatic cancer in someone who is considered to be at high risk?
Nowadays, with the technology provided by secretin stimulation (a hormone given to increase secretions within the pancreatic gland and enhance the detail within the ducts and the connections between the pancreatic cysts) and with intravenous and oral contrast enhanced MRI, the detail provided of the pancreatic gland is much more reliable than a few years ago to examine this organ.
In a circumstance where there is concern regarding the possibility of a genetic syndrome or a familial condition, input from a genetic counselor is invaluable. Particularly, if there is a younger 1st degree family member (under the age of 50) or more than 2 or 3 family members with cancers, one should start considering the option of a genetic evaluation.
Endoscopic ultrasound (EUS) is a helpful tool in evaluating the pancreatic gland. This technology involves the use of an endoscope passed through the esophagus into the stomach and small intestine. From this area, the pancreas can be reached for evaluation. The benefit of this procedure is that samples of fluid and tissue can be obtained at the same time and combining the EUS technology with MRI can be complementary and can increase the yield of discovering lesions earlier.
Is pancreatic cancer screening covered by insurance?
Generally patients who have a reasonable risk of pancreatic cancer based on their history are often eligible for evaluation and testing, which could include imaging, genetic testing, and/or procedures for sampling of the pancreas.
Examples of genetic predisposition would be a person who has Lynch syndrome (a colon cancer syndrome) or BRCA2 mutation (a breast cancer syndrome) or Peutz-Jeghers syndrome, all of which carry with them an increased risk of pancreatic cancer. A family history of pancreatic cancer can increase an individual’s risk. A pancreatic abnormality, such as a cyst/mass in the pancreas, in specific cases, could increase one’s risk of pancreatic cancer.
What is the preparation involved for an EUS procedure?
Usually the patient would fast the night before the procedure and may need to hold certain medications ahead of the procedure, such as blood thinners, to reduce the risk of bleeding. The procedure takes on average about 45 minutes to 90 minutes.
What is the turnaround time for results?
MRI results are usually available within 1 week after the study and the EUS findings are usually also available within the same time period. Genetic testing can take on average about 2-4 weeks to be resulted.
Are there clinical trials available in the area?
The imaging technology has improved significantly over the past decade and smaller and earlier lesions can be detected by currently available MRI and endoscopic ultrasound imaging in expert hands. In addition, for those who are willing, there are ongoing trials in the region, where excretions from the pancreas are collected in hopes to discover tumor markers that may ‘hint’ at the development of pancreatic cancer even before there are imaging changes discoverable by MRI or EUS. So, for those patients who are highly motivated, and are willing to undergo more aggressive follow-up and screening for pancreatic cancer as part of a clinical trial, they could enroll in the Johns Hopkins – The Cancer of the Pancreas Screening (CAPS5) trial. For those patients that are interested, we would refer them to be seen in New Haven at the Smilow Cancer Center in order to be closely followed there as part of this nationwide trial.
