Pancreatic Cancer: A Multidisciplinary Approach: A Multidisciplinary Approach

Description

This book provides a comprehensive, state-of-the-art overview of pancreatic cancer. The text presents new data about risk factors and genetic predisposition for pancreatic cancer, highlights current screening strategies and preliminary results, and reviews diagnosis and staging of pancreatic cancer, with a focus on imaging evaluations, laparoscopy, endoscopic ultrasound-guided biopsies, and biomarkers. The book also spotlights emerging paradigms in pancreatic cancer management, such as minimally invasive surgical approaches and emerging radiation approaches, and provides valuable insight into the role of nutrition and early integration of supportive/palliative care for pancreatic cancer patients.  Written by experts in the field, Pancreatic Cancer: A Multidisciplinary Approach is an invaluable resource for physicians and researchers with an interest in pancreatic cancer. Foreword: The Evolution of Pancreatic Cancer Care Preface Contents Contributors 1: Pancreatic Cancer at a Glance Introduction Incidence Prevalence Mortality Human Development Index Incidence Projections Mortality Projections Conclusion References 2: Risk Factors and Genetic Predisposition Smoking Obesity Alcohol Chronic Pancreatitis Family History Genetic Predisposition References 3: Pancreatic Cancer and Diabetes Mellitus Background Multidirectional Interaction Between DM and PDAC (Fig. 3.1) Pathogenesis of Glycemic Disturbance due to PDAC New-Onset Diabetes as a Harbinger of PDAC Efforts to Use NOD for Early Detection of PDAC Summary References 4: Pancreatic Cancer Screening Introduction Pancreatic Cancer Risk Factors Pancreatic Cancer Precursor Lesions Who Should Be Screened? Screening Tests Screening Guidelines and Strategies MD ANDERSON Screening Algorithm Benefits and Harms Psychological Impact of Pancreatic Cancer Screening Future Directions Conclusions References Part I: Diagnosis and Staging of Pancreatic Cancer 5: Diagnosis and Staging of Pancreatic Cancer: Imaging Evaluations—Pancreatic Protocol CT and MRI, PET-CT Computed Tomography CT Protocol Diagnosis Differential Diagnosis Staging Positron Emission Tomography/Computed Tomography PET/CT Protocol Diagnosis Staging Treatment Response Detection of Recurrent Disease Magnetic Resonance Imaging MRI Protocol Diagnosis Staging Assessment of Recurrent Cancer Conclusion References 6: Diagnosis and Staging of Pancreatic Cancer: Laparoscopy Introduction History Review of Contemporary Data Diagnostic Accuracy and Outcomes Cost-Effectiveness Principles of Management Indications Preoperative Setting Staging Clarification Prior to Upfront Surgical Resection or Neoadjuvant Therapy Staging Clarification During Neoadjuvant Therapy Risk Stratification Prior to Surgery Intraoperative Setting Staging Clarification Immediately before Laparotomy Postoperative Setting Staging Clarification for Adjuvant Therapy Biospecimen Acquisition Technical Points Drawbacks Conclusion References 7: Diagnosis and Staging of Pancreatic Cancer: Role of Gastroenterologist: Endoscopic Ultrasound (EUS), EUS-Guided Biopsy Introduction Detection and Diagnosis Staging Management Adjuvant Molecular Testing Conclusion References 8: Diagnosis and Staging of Pancreatic Cancer: Role of Ca 19-9 in Diagnosis/Staging and Management References Part II: Management of Locally Advanced/Metastatic Disease 9: Management of Locally Advanced/Metastatic Disease: Medical Oncology Introduction Locally Advanced Disease Metastatic Disease Approach to LAPC at MD Anderson MD Anderson Approach to Metastatic Pancreatic Cancer Conclusion References 10: Management of Locally Advanced/Metastatic Disease: Radiation Oncology Introduction Radiation Therapy Treatment Strategies for Unresectable Disease Chemoradiation Proton and Carbon Ion Therapy Stereotactic Body Radiation Therapy (SBRT) Magnetic Resonance Linac-Based Treatment Treatment Planning Procedures Pre-simulation Instructions Patient Set-Up Image Acquisition Treatment Planning Planning Aims and Dose Constraints Treatment Verification Summary References Part III: Management of Resectable and Borderline Resectable Disease 11: Management of Resectable and Borderline Resectable Disease: Surgery Introduction History of Pancreatoduodenectomy Preoperative Management Preoperative Period: Opportunity for Optimization Decision for Surgery Operative Steps Pancreatoduodenectomy Considerations for Vein Involvement Reconstruction Distal Pancreatectomy Postoperative Management Enhanced Recovery Quality Measures Future Directions References 12: Management of Resectable and Borderline Resectable Disease: Medical Oncology Introduction Definition of Resectability Adjuvant Therapy Borderline Resectable PDAC Neoadjuvant Therapy for PDAC Role of Neoadjuvant Chemotherapy without Radiation Locally Advanced PDAC What Is the Role of Radiotherapy in the Neoadjuvant Setting for PDAC? Histopathologic Assessment Following Neoadjuvant Therapy Tumor Surveillance in PDAC Using Circulating DNA (ctDNA) Neoadjuvant Therapy Followed by Metastasectomy for PDAC References 13: Management of Resectable and Borderline Resectable Disease: Radiation Oncology Introduction Indications for Radiation Adjuvant Radiation Neoadjuvant Radiation Definitive Radiation The Impact of Advanced Technologies in Radiation Delivery Imaging and Target Delineation Internal Motion Management Image-Guided Radiation Therapy MR-Linac Innovations in Radiation Techniques Intensity-Modulated Radiation Therapy SBRT Particle Beam Radiation Conclusions References Part IV: Endoscopic Management of Pancreatic Cancer Symptoms 14: Jaundice/Biliary Obstruction: ERCP/EUS BD Introduction Options for Biliary Decompression References 15: Gastric Outlet Obstruction: Antroduodenal Stenting, Venting PEG, EUS Guided Gastrojejunostomy Introduction Pathophysiology Diagnosis Principles of Management Surgical Gastrojejunostomy Enteral Stent Placement Technique Outcomes and Efficacy Adverse Events Enteral Stents Versus Surgical Gastrojejunostomy EUS-Guided Gastroenterostomy Technique Outcomes and Efficacy EUS-GE Versus Surgical Gastrojejunostomy EUS-GE Versus Enteral Stents Adverse Events Venting Gastrostomy Special Considerations mGOO in the Post-Whipple Anatomy Delayed Gastric Emptying Summary and Management Algorithm References 16: Pain Control: Celiac Plexus Neurolysis Percutaneous Celiac Plexus Neurolysis Method Anterior Approach Posterior Approach Complications Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis Method Instruments Drugs Procedure Bilateral Approach (Fig. 16.1) Central Injection Approach (Fig. 16.2) Complications References Part V: Emerging Paradigms in Pancreatic Cancer 17: Minimally Invasive Surgical Approaches Introduction Minimally Invasive DP Minimally Invasive PD Foregut Robotic Surgery Program at MD Anderson Conclusion References 18: EUS-Guided Local Therapies Introduction EUS-Guided Fine Needle Injection of Anti-Tumor Agents EUS-Assisted Radiotherapy EUS-Guided Brachytherapy EUS-Guided Fiducial Placement EUS-Guided Tumor Ablation Conclusion References 19: Imaging-Based Biomarkers for Pancreatic Cancer Introduction: Different Contexts of Imaging for Pancreatic Cancer and How Imaging-Derived Biomarkers May Play a Role Considerations for Early Detection Prognostic Stratification of Tumors Treatment Response Specific Imaging Modalities Endoscopic Ultrasound {EUS} Computed Tomography (CT) MRI Artificial Intelligence Future Applications References 20: Liquid Biopsies in Pancreatic Cancer Introduction CTCs in Pancreatic Cancer Circulating Free DNA (cfDNA) and Circulating Tumor DNA (ctDNA) EVs References 21: Molecular Profiling and Precision Medicine for Pancreatic Cancer Introduction Sequencing Efforts Have Revealed Actionable Mutations Best Examples to Date BRCA1/2 (and PALB2) MSI-High NTRK Promising Targets Other DDR Mutations KRAS Wild Type PDAC: Mutations in BRAF, and Other Receptor Tyrosine Kinases Targeting the WNT Pathway: RNF43 Mutations and RSPO2/3 Fusions Survival Benefit—A National Registry for Precision Medicine (the Know Your Tumor Program) Elusive Drivers KRAS, TP53, CDKN2A/2B, and SMAD4 Immunotherapy Future Directions: Other Considerations and Biomarker Driven Approaches Concluding Remarks References 22: The Prospects of Immunotherapy in Pancreatic Cancer The Formation of Immune-Suppressive Microenvironment Tumor Cell-Intrinsic Factors Stroma Fibroblast T Lymphocytes Myeloid Cells Metabolism Environment Microbiome The Current Status and Prospect of Immunotherapy Immune Checkpoint Blockade Tumor Vaccine Adoptive Cell Therapy (ACT) Targeting TME Conclusion References 23: Microbiome in Pancreatic Cancer Introduction on Microbiome Microbial Biomarkers in Pancreatic Cancer Role of Pancreatic Microbiome in Preclinical Studies: Exploring Functional Relevance Ongoing Clinical Trials for Targeting the Microbiome During Cancer References 24: Early Drug Development in Pancreatic Cancer Introduction Targeting the Tumor Microenvironment T-Cell Checkpoint Inhibitors Other Immune Based Strategies Targeting the Stroma Targeting Tumor Cells KRAS-Based Targets Autophagy Other Targets Conclusions References 25: Mechanisms and Evidence on Pancreatic Cancer Prevention Introduction Metformin General Background and PC Risk Association Anti-tumoral and Immunomodulatory Mechanisms Clinical Use and Potential for PC Prevention Statins General Background and PC Risk Association Anti-tumoral and Immunomodulatory Mechanisms Clinical Use and Potential for PC Prevention Aspirin General Background and PC Risk Association Anti-tumoral and Immunomodulatory Mechanisms Clinical Use and Potential for PC Prevention Vitamin D General Background and PC Risk Association Anti-tumoral and Immunomodulatory Mechanisms Clinical Use and Potential for PC Prevention Vitamin C General Background and PC Risk Association Anti-tumoral and Immunomodulatory Mechanisms Clinical Use and Potential for PC Prevention Vitamin E General Background and PC Risk Association Anti-tumoral and Immunomodulatory Mechanisms Clinical Use and Potential for PC Prevention Antibiotics General Background and PC Risk Association Anti-tumoral and Immunomodulatory Mechanisms Clinical Use and Potential for PC Prevention Immune Checkpoint Inhibitors General Background and PC Risk Association Anti-tumoral and Immunomodulatory Mechanisms Clinical Use and Potential for PC Prevention Conclusions and Perspective References 26: Nutrition in Pancreatic Cancer Introduction Malnutrition, Cachexia, and Sarcopenia Cachexia Sarcopenia Nutrition Screening Malnutrition, Cachexia, and Sarcopenia Interventions in Pancreatic Cancer Nutrition Intervention Nutrient Needs Calorie Needs Protein Needs Micronutrient Needs Common Nutrition Issues in PC Diabetes Mellitus and Hyperglycemia Gastric Outlet Obstruction and Small Bowel Obstruction Delayed Gastric Emptying Pancreatic Exocrine Insufficiency (PEI) Management of PEI Pancreatic Enzyme Replacement Therapy PERT Optimization and Troubleshooting Diet Modification for Malabsorption Diarrhea Absorptive Fiber Other Considerations Special Populations: Perioperative Nutrition, Nutrition at End of Life, Long-Term Survivors Perioperative Nutrition Preoperative Nutrition Postoperative Nutrition Energy Needs Nutrition for Surgical Complications Rapid GI Transit or Dumping Syndrome Pancreatic Fistula Chyle Leak Nutrition Support End of Life Ascites Long-Term Survivors Summary References 27: Prioritizing the Patient Experience: Early Integration of Supportive/Palliative Care in Pancreatic Cancer Management Introduction Early Integrated Palliative Care in Patients with Cancer Toxicities and Healthcare-Related Quality of Life Outcomes of Systemic Therapy Integration of Health Care Related Quality of Life Measures into Clinical Trials Providing Holistic Care for Patients with Pancreatic Cancer Underutilization of Palliative Care in Cancer Therapy and Barriers to Earlier Integration of Palliative Care References 28: Patient Reported Outcomes and Quality of Life Introduction Definitions of Quality of Life Potential QoL Tools That Can Be Optimally Implemented for Patients with PDAC Associated Tools to Collect Patient Reported Outcomes Challenges in Implementing QoL Measures Into Clinical Trials Statistical Challenges and Opportunities Related to QoL Analyses QoL Clinical Studies QoL Studies in Resectable Disease and Prior to Surgery QoL in Adjuvant Therapy Studies Neoadjuvant and Definitive Therapy: Resectable, Borderline Resectable, and Locally Advanced Pancreatic Cancer Metastatic Disease Elderly and Poor Performance Status Patients Future Directions References 29: Integrative Medicine in Pancreatic Cancer Introduction Definitions Utilization Communication The Evidence Supplements Mind-Body Practices Massage Acupuncture Educational Resources Integrative Oncology in Clinical Practice Conclusion References Index