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Pancreatic Cancer

Wendy K Chung, MD

Pancreatic cancer often spreads through local invasion into local structures, including fat, blood vessels, nerves, and nearby organs (stomach, duodenum, spleen, bile duct). Local microscopic invasion is associated with recurrence of pancreatic cancer after pancreatic resection, such that even if the original cancer is surgically removed, microscopic areas of cancer often remain. Data on the patterns of local invasion by pancreatic cancer have not been published. In this study, The investigators hope to investigate the frequency of the various methods of local invasion of pancreatic adenocarcinoma. This would help the investigators better understand how pancreatic cancer spreads, and determine what cancers are not resectable.

Pancreatic cancer is the eighth most common malignancy, and the fifth leading cause of cancer-related death, in the United States. Unfortunately, patients often present late in the course of the disease. Accordingly, the 1- year survival rate is approximately 20%, and the 5-year survival rate is less than 4%. Even in patients with local disease who are surgical candidates, survival at five years remains only 10-25%. Staging for pancreatic adenocarcinoma typically utilizes the TNM classification, where "T" represents tumor size, "N" represents regional lymph node metastasis, and "M" represents distant metastasis. This type of staging can usually only be done after operative resection. Unfortunately, up to 25% of patients are found to be unresectable at the time of surgical exploration. This is most often due to local invasion or metastatic disease. Local microscopic invasion is associated with recurrence of pancreatic cancer after pancreatic resection. Comprehensive data on the patterns of local invasion by pancreatic cancer have not been published. The investigators believe that it would be beneficial to investigate the frequency of the various methods of local invasion of pancreatic adenocarcinoma. A clearer understanding of the natural history of local invasion could potentially lead to a better determination of what constitutes unresectability.

Frequency of Methods of Local Invasion of Pancreatic Adenocarcinoma

The clinical and pathology information from the CUMC surgical database will be reviewed to determine the frequency of the various modalities of local invasion of pancreatic adenocarcinoma. This includes: peripancreatic fat invasion, neural/perineural invasion, vascular invasion, macrovascular invasion, duodenal invasion, bile duct invasion, splenic invasion,and gastric invasion.

Columbia University

Disease Progression

Gastrointestinal Agents

All Drugs and Chemicals

Pancrelipase

Pancreatin

Patients with a strong family history of pancreatic cancer or with a genetic syndrome that puts them at risk for pancreas cancer.

Patients who underwent surgery for pancreatic cancer and developed tumor recurrence after surgery

The research purpose of this project is to create a registry, and blood and tissue bank for individuals at high-risk for pancreatic cancer. We plan to conduct histopathological and molecular analysis of resected pancreatic tissue prospectively collected from a cohort of pancreatic cancer patients.

Pancreatic cancer is the fifth leading cause of cancer-related death in the United States. In order to improve outcomes of this disease, significant research efforts have focused on understanding the changes that occur in the pancreas prior to tumor occurrence. The types of changes most often associated with tumor have been named pancreatic intraepithelial neoplasia (PanIN). It is not yet clear how to identify the PanIN lesions most likely to develop into cancer and the length of time required for this progression. In order to evaluate these questions, we are interested in examining the microscopic and genetic characteristics of PanIN lesions in two "high-risk" patients: 1) patients who underwent surgery for pancreatic cancer and developed tumor recurrence after surgery and 2) patients with a strong family history of pancreatic cancer or with a genetic syndrome that puts them at risk for pancreas cancer. The surgical specimens from these patients will be evaluated by a pathologist for evidence of widespread PanIN lesions. In addition, PanIN lesions will be tested for abnormalities in several major genes that are known to be important in pancreatic cancer.

* Blood samples
* Specimens of tumors, pre-cancerous lesions, and normal tissue from patients who need to have endoscopy or surgery for diagnosis or treatment of tumors that develop
* Samples of urine and stool, and duodenal aspirates if an individual will be having an endoscopy

Pancreatic Intraepithelial Neoplasia (PanIN) and the Association With Recurrence of Pancreatic Adenocarcinoma

Refining the Molecular Progression From Intraductal to Invasive Pancreatic Cancer: Correlating Genetic Profiles and Clinicopathological Phenotypes in Sporadic and Familial Pancreatic Adenocarcinoma

Distinctive histological features of PanIN within surgical specimens of our two study groups will be assessed by pathologists.

Using microarray-based comparative genomic hybridization (aCGH) to evaluate the samples.

aCGH will also be utilized to evaluate recurrence mechanism in a set of cases in which both original tumor and recurrence tumor was resected, allowing for clonal origins to be evaluated.

Study title	NCT ID	Conditions	Eligibility	Organization
Frequency of Methods of Local Invasion of Pancreatic Adenocarcinoma	NCT01129167	Pancreatic Canc...	18 Years - 85 Years	Columbia University
Pancreatic Intraepithelial Neoplasia (PanIN) and the Association With Recurrence of Pancreatic Adenocarcinoma	NCT01219829	Pancreatic Canc...	18 Years - 85 Years	Columbia University
Frequency of Methods of Local Invasion of Pancreatic Adenocarcinoma	NCT01129167	Pancreatic Canc...	18 Years - 85 Years	Columbia University
Pancreatic Intraepithelial Neoplasia (PanIN) and the Association With Recurrence of Pancreatic Adenocarcinoma	NCT01219829	Pancreatic Canc...	18 Years - 85 Years	Columbia University
Frequency of Methods of Local Invasion of Pancreatic Adenocarcinoma	NCT01129167	Pancreatic Canc...	18 Years - 85 Years	Columbia University

Spots Global Cancer Trial Database for recurrence of pancreatic cancer