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Chronische Pankreatitis als Risikofaktor für ein Pankreaskarzinom – diagnostische Herausforderungen

Chronic Pancreatitis as a Risk Factor for the Development of Pancreatic Cancer – Diagnostic Challenges

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Zusammenfassung

Die chronische Pankreatitis geht mit einem erhöhten Risiko einher, ein Adenokarzinom des Pankreas zu entwickeln. Bis heute existieren keine etablierten Strategien zur Früherkennung des Pankreaskarzinoms bei Patienten mit chronischer Pankreatitis. Der Grund dafür liegt in der unzureichenden Sensitivität und Spezifität klinischer, bildgebender und serologischer Verfahren zur Diagnostik des Karzinoms in einer chronischen Pankreatitis. Ungeachtet dieser Schwierigkeiten sollten Patienten mit klinischem Verdacht auf ein Pankreaskarzinom sorgfältig und ggf. wiederholt untersucht werden. Der Stellenwert von Screeningmaßnahmen bei Patienten mit chronischer Pankreatitis außerhalb von kontrollierten Studien ist nicht gut belegt. Berichtet wird der Fall eines 51-jährigen Patienten mit einer chronischen Pankreatitis, bei dem sich unter engmaschigen bildgebenden Untersuchungen ein duktales Adenokarzinom des Pankreaskopfes entwickelt hat.

Abstract

Patients with chronic pancreatitis are burdened with an increased risk of developing pancreatic cancer. Strategies or guidelines for the surveillance and early detection of pancreatic adenocarcinoma in patients with chronic pancreatitis are not established, because available clinical, serologic or imaging techniques are still of limited sensitivity and specificity. Despite these limitations do patients with chronic pancreatitis and suspected pancreatic cancer need a careful and sometimes repeated diagnostic work-up. A clear benefit of surveillance programs outside of clinical trials for the early detection of pancreatic cancer has not been demonstrated. A 51-year-old patient with chronic pancreatitis is reported who developed cancer of the pancreatic head while undergoing repeated imaging studies.

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Literatur

  1. Lowenfels AB, Maisonneuve P, Cavallini G, et al. Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med 1993;328:1433–7.

    Article  CAS  PubMed  Google Scholar 

  2. Lowenfels AB, Maisonneuve P, DiMagno EP, et al. Hereditary pancreatitis and the risk of pancreatic cancer. International Hereditary Pancreatitis Study Group. J Natl Cancer Inst 1997;89:442–6.

    Article  CAS  PubMed  Google Scholar 

  3. de Icaza E, López-Cervantes M, Arredondo A, Robles-Díaz G. Likelihood ratios of clinical, laboratory and image data of pancreatic cancer: Bayesian approach. J Eval Clin Pract 2009;15:62–8.

    Article  PubMed  Google Scholar 

  4. Whitcomb DC. Genetic predispositions to acute and chronic pancreatitis. Med Clin North Am 2000;84:531–47, vii.

    Article  CAS  PubMed  Google Scholar 

  5. Whitcomb DC. Genetic predisposition to alcoholic chronic pancreatitis. Pancreas 2003;27:321–6.

    Article  PubMed  Google Scholar 

  6. Comfort MW, Steinberg AG. Pedigree of a family with hereditary chronic relapsing pancreatitis. Gastroenterology 1952;21:54–63.

    CAS  PubMed  Google Scholar 

  7. Whitcomb DC, Gorry MC, Preston RA, et al. Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene. Nat Genet 1996;14:141–5.

    Article  CAS  PubMed  Google Scholar 

  8. Simon P, Weiss FU, Sahin-Toth M, et al. Hereditary pancreatitis caused by a novel PRSS1 mutation (Arg-122 -> Cys) that alters autoactivation and autodegradation of cationic trypsinogen. J Biol Chem 2002;277:5404–10.

    Article  CAS  PubMed  Google Scholar 

  9. Ellis I, Lerch MM, Whitcomb DC. Genetic testing for hereditary pancreatitis: guidelines for indications, counselling, consent and privacy issues. Pancreatology 2001;1:405–15.

    Article  CAS  PubMed  Google Scholar 

  10. Ekbom A, McLaughlin JK, Karlsson BM, et al. Pancreatitis and pancreatic cancer: a population-based study. J Natl Cancer Inst 1994;86:625–7.

    Article  CAS  PubMed  Google Scholar 

  11. Howes N, Lerch MM, Greenhalf W, et al., European Registry of Hereditary Pancreatitis and Pancreatic Cancer (EUROPAC). Clinical and genetic characteristics of hereditary pancreatitis in Europe. Clin Gastroenterol Hepatol 2004;2:252–61.

    Article  CAS  PubMed  Google Scholar 

  12. Rebours V, Boutron-Ruault MC, Schnee M, et al. Risk of pancreatic adenocarcinoma in patients with hereditary pancreatitis: a national exhaustive series. Am J Gastroenterol 2008;103:111–9.

    PubMed  Google Scholar 

  13. Lowenfels AB, Maisonneuve P, Whitcomb DC, et al. Cigarette smoking as a risk factor for pancreatic cancer in patients with hereditary pancreatitis. JAMA 2001;286:169–70.

    Article  CAS  PubMed  Google Scholar 

  14. Pannala R, Basu A, Petersen GM, Chari ST. New-onset diabetes: a potential clue to the early diagnosis of pancreatic cancer. Lancet Oncol 2009;10:88–95.

    Article  PubMed  Google Scholar 

  15. Mayerle J, Stier A, Lerch MM, Heidecke CD. [Chronic pancreatitis. Diagnosis and treatment.] Chirurg 2004;75:731–47, quiz 748.

    Article  CAS  PubMed  Google Scholar 

  16. Kelsen DP, Portenoy R, Thaler H, et al. Pain as a predictor of outcome in patients with operable pancreatic carcinoma. Surgery 1997;122:53–9.

    Article  CAS  PubMed  Google Scholar 

  17. Fazel A, Draganov P. Interventional endoscopic ultrasound in pancreatic disease. Curr Gastroenterol Rep 2004;6:104–10.

    Article  PubMed  Google Scholar 

  18. Midwinter MJ, Beveridge CJ, Wilsdon JB, et al. Correlation between spiral computed tomography, endoscopic ultrasonography and findings at operation in pancreatic and ampullary tumours. Br J Surg 1999;86:189–93.

    Article  CAS  PubMed  Google Scholar 

  19. Agarwal B, Kuehn S, Collins BT. Endoscopic ultrasound after preoperative chemoradiation can help identify patients who benefit maximally after surgical esophageal resection. Am J Gastroenterol 2004;99:1258–66.

    Article  PubMed  Google Scholar 

  20. Catalano MF, Lahoti S, Geenen JE, Hagan WJ. Prospective evaluation of endoscopic ultrasonography, endoscopic retrograde pancreatography, and secretin test in the diagnosis of chronic pancreatitis. Gastrointest Endosc 1998;48:11–7.

    Article  CAS  PubMed  Google Scholar 

  21. Agarwal B, Abu-Hamda E, Molke KL, et al. Endoscopic ultrasound-guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer. Am J Gastroenterol 2004;99:844–50.

    Article  PubMed  Google Scholar 

  22. Steinberg W. Chronic pancreatic pain: cut for cure? Am J Gastroenterol 1990;85:1427–8.

    CAS  PubMed  Google Scholar 

  23. Lohr M, Maisonneuve P, Lowenfels AB. K-Ras mutations and benign pancreatic disease. Int J Pancreatol 2000;27:93–103.

    Article  CAS  PubMed  Google Scholar 

  24. Chari ST, Smyrk TC, Levy MJ, et al. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol 2006;4:1010–6, quiz 934.

    Article  PubMed  Google Scholar 

  25. Pickartz T, Mayerle J, Lerch MM. Autoimmune pancreatitis. Nat Clin Pract Gastroenterol Hepatol 2007;4:314–23.

    Article  CAS  PubMed  Google Scholar 

  26. Pickartz T, Pickartz H, Lochs H, Ockenga J. Overlap syndrome of autoimmune pancreatitis and cholangitis associated with secondary Sjogren's syndrome. Eur J Gastroenterol Hepatol 2004;16:1295–9.

    Article  PubMed  Google Scholar 

  27. Chari ST, Longnecker DS, Kloppel G. The diagnosis of autoimmune pancreatitis: a Western perspective. Pancreas 2009;38:846–8.

    Article  PubMed  Google Scholar 

  28. Brand RE, Lerch MM, Rubinstein WS, et al. Advances in counselling and surveillance of patients at risk for pancreatic cancer. Gut 2007;56:1460–9.

    Article  PubMed  Google Scholar 

  29. Rulyak SJ, Brentnall TA. Inherited pancreatic cancer: improvements in our understanding of genetics and screening. Int J Biochem Cell Biol 2004;36:1386–92.

    Article  CAS  PubMed  Google Scholar 

  30. Canto MI, Goggins M, Hruban RH, et al. Screening for early pancreatic neoplasia in high-risk individuals: a prospective controlled study. Clin Gastroenterol Hepatol 2006;4:766–81, quiz 665.

    Article  PubMed  Google Scholar 

  31. Langer P, Kann PH, Fendrich V, et al. Five years of prospective screening of high-risk individuals from families with familial pancreatic cancer. Gut 2009;58:1410–8.

    Article  CAS  PubMed  Google Scholar 

  32. Poley JW, Kluijt I, Gouma DJ, et al. The yield of first-time endoscopic ultrasonography in screening individuals at a high risk of developing pancreatic cancer. Am J Gastroenterol 2009;104:2175–81.

    Article  CAS  PubMed  Google Scholar 

  33. Choudari CP, Nickl NJ, Fogel E, et al. Hereditary pancreatitis: clinical presentation, ERCP findings, and outcome of endoscopic therapy. Gastrointest Endosc 2002;56:66–71.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Innere Medizin A, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Germany

    Tilman Pickartz, Julia Mayerle, Matthias Kraft &  Markus M. Lerch

  2. Institut für Pathologie, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Germany

    Matthias Evert & Katja Evert

  3. Institut für Radiologie, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Germany

    Jens-Peter Kühn

  4. Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Germany

    Claus-Dieter Heidecke

  5. Klinik und Poliklinik für Innere Medizin A, Klinikum der Ernst-Moritz-Arndt-Universität, Friedrich-Löffler-Straße 23a, 17487, Greifswald, Germany

    Markus M. Lerch

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  1. Tilman Pickartz
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  2. Julia Mayerle
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  3. Matthias Kraft
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  4. Matthias Evert
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  7. Claus-Dieter Heidecke
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  8. Markus M. Lerch
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Correspondence to Markus M. Lerch.

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Pickartz, T., Mayerle, J., Kraft, M. et al. Chronische Pankreatitis als Risikofaktor für ein Pankreaskarzinom – diagnostische Herausforderungen. Med Klin 105, 281–285 (2010). https://doi.org/10.1007/s00063-010-1042-6

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  • DOI: https://doi.org/10.1007/s00063-010-1042-6

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