World Pancreatic Cancer Awareness Month 

Pancreatic cancer has now become the third leading cause of cancer deaths in Australia and the survival rate still lies around one of the lowest at 11.5%. Little awareness of signs and symptoms leads to late diagnosis and poor prognosis. Current treatment options for pancreatic cancer are limited and not very effective. Please join us in raising awareness, supporting patients, families and researchers this month. Please join us in raising awareness, supporting patients, families and researchers this month. More information and useful resources can be found on Australian Pancreatic Cancer Foundation website. 

UpToDate

Diagnosis

• Clinical manifestations, diagnosis, and staging of exocrine pancreatic cancer
• Molecular pathogenesis of exocrine pancreatic cancer
• Endoscopic ultrasound in the staging of exocrine pancreatic cancer
• Pathology of exocrine pancreatic neoplasms

General

• Society guideline links: Pancreatic cancer
• Overview of the complications of chronic pancreatitis

Risk factors

• Epidemiology and nonfamilial risk factors for exocrine pancreatic cancer
• Familial risk factors for pancreatic cancer and screening of high-risk patients

Treatment

• Overview of surgery in the treatment of exocrine pancreatic cancer and prognosis
• Initial systemic chemotherapy for metastatic exocrine pancreatic cancer
• Treatment for potentially resectable exocrine pancreatic cancer
• Initial chemotherapy and radiation for nonmetastatic, locally advanced, unresectable and borderline resectable, exocrine pancreatic cancer
• Second-line systemic therapy for advanced exocrine pancreatic cancer
• Supportive care of the patient with locally advanced or metastatic exocrine pancreatic cancer
• Treatment protocols for pancreatic cancer

Cochrane Library

• Extended lymph node resection versus standard resection for pancreatic and periampullary adenocarcinoma
• Treatment for gastrointestinal and pancreatic neuroendocrine tumours: a network meta‐analysis

Articles

Diagnosis

• The clinical and genetic features of hereditary pancreatitis in South Australia
• Prediction model for early-stage pancreatic cancer using routinely measured blood biomarkers
• High-dimensional deconstruction of pancreatic cancer identifies tumor microenvironmental and developmental stemness features that predict survival
• Improving Pancreatic cyst management: Artificial Intelligence-powered prediction of advanced Neoplasms through Endoscopic Ultrasound-Guided Confocal Endomicroscopy
• Identification of diagnostic markers of pancreatic ductal adenocarcinoma using transcriptomic tumour and blood sample data
• Coagulation parameters for the differential diagnosis of pancreatic cancer in the early stage: a retrospective study

Risks

• The burden of pancreatic cancer in Australia attributable to smoking
• Chronic pancreatitis
• Long-term outcomes and risk of pancreatic cancer in intraductal papillary mucinous neoplasms
• Association between Polycystic Ovary Syndrome and risk of Pancreatic Cancer
• Risk of syndrome-associated cancers among first-degree relatives of patients with Pancreatic Ductal Adenocarcinoma with pathogenic or likely pathogenic germline variants
• Pancreatic Cyst features predict for future development of Pancreatic Cancer: Results of a nested case-control study

Treatment

• Sotorasib in KRAS p.G12C–Mutated advanced pancreatic cancer
• Five-year outcomes of FOLFIRINOX vs Gemcitabine as adjuvant therapy for Pancreatic Cancer: A randomized clinical trial
• Adaptive dynamic therapy and survivorship for operable Pancreatic Cancer
• Minimally invasive versus open distal pancreatectomy in the 2020s: Recent institutional experience and a narrative review of current evidence
• EUS-guided radiofrequency ablation plus chemotherapy versus chemotherapy alone for pancreatic cancer (ERAP): An observational open-label pilot study
• Research trends on immunotherapy for pancreatic cancer: A bibliometric analysis

E-books

• A sample of e-books available via the library catalogue

E-journals

• A sample of e-journals available via the library catalogue

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Articles

Diagnosis

The clinical and genetic features of hereditary pancreatitis in South Australia

• The known: Hereditary pancreatitis typically commences during childhood and leads to lifelong disability and increased risk of pancreatic cancer. Its clinical and genetic features have not been characterised in a population‐based study in Australia.
• The new: Twenty‐five of 44 South Australians with confirmed hereditary pancreatitis during 2006–21 were Indigenous people (57%), and the estimated prevalence was much higher for Indigenous Australians than other people (71 v 1.1 per 100 000 population). A large proportion of people with hereditary pancreatitis (86%) required prescribed opioids for pain relief.
• The implications: Hereditary pancreatitis should be considered as a cause of early onset pancreatitis, particularly in young Indigenous people.

MJA 23 May 2022

Prediction model for early-stage pancreatic cancer using routinely measured blood biomarkers
In this diagnostic study of patients with pancreatic cancer or benign periampullary diseases, an easily applicable risk score showed high accuracy for distinguishing early-stage pancreatic cancer from benign periampullary diseases. This model could be used to assess the added diagnostic and clinical value of novel biomarkers and prevent potentially unnecessary invasive diagnostic procedures for patients at low risk. JAMA 28 August 2023

High-dimensional deconstruction of pancreatic cancer identifies tumor microenvironmental and developmental stemness features that predict survival
The authors identified tumor microenvironmental and developmental stemness characteristics from a high-dimensional gene expression analysis of pancreatic ductal adenocarcinoma (PDAC) using human tissue specimens, including time-of-diagnosis endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) samples. These reveal new connections between tumor microenvironmental composition, CAF and malignant cell stemness, and patient survival that could lead to better upfront risk stratification and more personalized upfront clinical decision-making. npj precision oncology 19 October 2023

Improving Pancreatic cyst management: Artificial Intelligence-powered prediction of advanced Neoplasms through Endoscopic Ultrasound-Guided Confocal Endomicroscopy
In this review, the authors explore current and future techniques to leverage these advanced technologies to improve diagnostic accuracy in the context of pancreatic cystic lesions (PCLs). Biometrics 19 October 2023

Identification of diagnostic markers of pancreatic ductal adenocarcinoma using transcriptomic tumour and blood sample data
The authors present a compilation of protein-coding markers and miRNAs that hold potential as a diagnostic tool for the early detection of PDAC, as well as for designing novel therapeutic strategies aimed at improving patient outcomes. Clinical and translational discovery 18 October 2023

Coagulation parameters for the differential diagnosis of pancreatic cancer in the early stage: a retrospective study
A significant hypercoagulable state was common in pancreatic cancer (PC). Some conventional coagulation (CC) and thromboelastography (TEG) parameters are valuable in the differential diagnosis of benign and malignant pancreatic diseases. In addition, coagulation indexes combined with CA199 can further enhance the differential diagnosis efficacy of CA199 in PC and early stage pancreatic cancer (EPC). European journal of medical research 17 October 2023

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Risks

The burden of pancreatic cancer in Australia attributable to smoking

• The known The future pancreatic cancer burden attributable to tobacco smoking has not been estimated in Australia.
• The new Nearly 22% of the future burden of pancreatic cancer is attributable to current and former smoking, 15% (5500 cases over the next 10 years) to current smoking alone. The smoking‐related burden of pancreatic cancer is markedly higher for men and for people under 65.
• The implications Reducing smoking rates among men and people under 65 would have the greatest impact on reducing the future burden of pancreatic cancer in Australia.

MJA 11 March 2019

Chronic Pancreatitis
Key clinical points

• Chronic pancreatitis, which is commonly associated with alcohol use, smoking, or genetic risk factors, often manifests as recurrent bouts of abdominal pain or pancreatitis. Characteristic imaging findings include pancreatic stones, dilated ducts, and atrophy.
• Complications of chronic pancreatitis include pseudocysts, biliary strictures, exocrine and endocrine pancreatic insufficiency, bone loss, and pancreatic cancer; there is currently no effective early detection strategy for pancreatic cancer.
• Exocrine insufficiency causing steatorrhea leads to weight loss, sarcopenia, and deficiencies of fat-soluble vitamins and other micronutrients and is mitigated by treatment with pancreatic-enzyme replacement.
• Strategies for managing chronic abdominal pain include medical therapies (analgesic agents, limited use of narcotics, antioxidants, and neuromodulators), endoscopic treatment (pancreatic stenting with or without extracorporeal shockwave lithotripsy), and surgical interventions (duct drainage and resection procedures), as well as behavioral interventions for centrally mediated pain.

NEJM 3 March 2022

Long-term outcomes and risk of pancreatic cancer in intraductal papillary mucinous neoplasms
In this study, computed tomography (CT)s identified intraductal papillary mucinous neoplasms (IPMNs) in approximately 10% of patients aged 50 years or older. Pancreatic cancer (PC) risk in patients with F-N IPMNs was low and not different compared with patients without IPMNs; approximately 10% of patients with PC had IPMN-PC, and they had better survival compared with patients with non-IPMN PC. JAMA 17 October 2023

Association between Polycystic Ovary Syndrome and risk of Pancreatic Cancer
A diagnosis of PCOS was associated with a 1.9-fold higher risk of pancreatic cancer, confirming the exploratory findings of Yin et al. This association was independent of BMI, largely not driven by type 2 diabetes, and robust to additional adjustment for several covariates and sensitivity analyses. These data suggest some individuals may have unknown metabolic derangements that may underly the development of both conditions. JAMA 6 October 2022

Risk of syndrome-associated cancers among first-degree relatives of patients with Pancreatic Ductal Adenocarcinoma with pathogenic or likely pathogenic germline variants
In this case series, the presence of pathogenic germline variants (PGVs) in 9 cancer syndrome–associated genes in pancreatic ductal adenocarcinoma (PDAC)  probands was found to be associated with increased risk of 6 types of cancers in first-degree relatives. These gene-specific PDAC and extra-PDAC cancer risks may provide justification for clinicians to counsel first-degree relatives about the relevance and importance of genetic cascade testing, with the goal of higher uptake of testing. JAMA 18 May 2023

Pancreatic Cyst features predict for future development of Pancreatic Cancer: Results of a nested case-control study
Age, cyst size, cyst growth rate, and high-risk or worrisome features are associated with higher risk of developing pancreatic cancer. Applying current and developing novel strategies are required to optimize early detection of pancreatic cancer after cyst diagnosis. Gastrointestinal endoscopy 17 October 2023

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Treatment

Sotorasib in KRAS p.G12C–Mutated advanced pancreatic cancer
Sotorasib showed anticancer activity and had an acceptable safety profile in patients with KRAS p.G12C–mutated advanced pancreatic cancer who had received previous treatment. NEJM 5 January 2023

Five-year outcomes of FOLFIRINOX vs Gemcitabine as adjuvant therapy for Pancreatic Cancer: A randomized clinical trial
The results of this randomized clinical trial found modified FOLFIRINOX to be a recommended adjuvant regimen following PDAC resection. JAMA 1 September 2022

Adaptive dynamic therapy and survivorship for operable Pancreatic Cancer
In this cohort study that sought to evaluate the role of adaptive dynamic therapy in localized pancreatic cancer, selecting a chemotherapeutic regimen based on response to preoperative therapy was associated with improved survival. These findings support an individualized and in vivo assessment of response to perioperative therapy in pancreatic cancer. JAMA 23 June 2022

Minimally invasive versus open distal pancreatectomy in the 2020s: Recent institutional experience and a narrative review of current evidence
These published studies will not only pave the way for establishing minimally invasive techniques for suitable patients, but also define their limitations and indications. Future studies will inform us about the oncological safety, cost effectiveness, overall survival and learning curves regarding patients undergoing minimally invasive distal pancreatectomy. Journal of clinical medicine 17 October 2023

EUS-guided radiofrequency ablation plus chemotherapy versus chemotherapy alone for pancreatic cancer (ERAP): An observational open-label pilot study
This study compared the results of treatment in patients receiving EUS-RFA plus concomitant CMT (group A; n = 14) with those receiving CMT (group B; n = 14) as a pilot study. In this study, the mean tumor diameter of group B was significantly increased after the treatment. Group A had a significantly higher rate of necrosis of tumor and required less narcotic. Endoscopic ultrasound 23 October 2023

Research trends on immunotherapy for pancreatic cancer: A bibliometric analysis
This study aims to summarize and visually analyze the current research status in pancreatic cancer immunotherapy during the past two decades by bibliometrics and explore the current research hotspots and future development directions. Human vaccines & immunotherapeutics 26 October 2023

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E-books

This is just a sample of the e-books the library subscribes to – you will need your library login

• Recent innovations in surgical procedures of pancreatic neoplasms (2023)
• Transplantation of the pancreas (2023)
• Odze and Goldblum surgical pathology of the GI tract, Liver, Biliary tract and pancreas (2023)
• Pathology of the pancreas (2022)
• Hepato-pancreato-biliary malignancies : diagnosis and treatment in the 21st century (2022)
• Imaging and pathology of pancreatic neoplasms : a pictorial atlas (2022)
• Pancreatic cancer : a multidisciplinary approach (2022)
• Pathology of the pancreas : a practical approach (2021)
• Imaging diagnostics in pancreatic cancer : a clinical guide (2021)
• Management of pancreatic cancer and cholangiocarcinoma (2021)
• Endoscopic ultrasound management of pancreatic lesions : from diagnosis to therapy (2021)
• Textbook of pancreatic cancer : principles and practice of surgical oncology (2021)

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E-Journals

This is just a sample of the journals the library subscribes to – you will need your library login

• Pancreas
• HPB : the official journal of the International Hepato Pancreato Biliary Association
• Hepatobiliary & pancreatic diseases international : HBPD INT
• Annals of hepato-biliary-pancreatic surgery
• Journal of pancreatology

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