New challenges in perioperative management of pancreatic cancer

Pancreatic ductal adenocarcinoma(PDAC)is the fourth leading cause of cancer-related death in the industrialized world.Despite progress in the understanding of the molecular and genetic basis of this disease,the5-year survival rate has remained low and usually does not exceed 5%.Only 20%-25%of patients present with potentially resectable disease and surgery represents the only chance for a cure.After decades of gemcitabine hegemony and limited therapeutic options,more active chemotherapies are emerging in advanced PDAC,like 5-Fluorouracil,folinic acid,irinotecan and oxaliplatin and nab-paclitaxel plus gemcitabine,that have profoundly impacted therapeutic possibilities.PDAC is considered a systemic disease because of the high rate of relapse after curative surgery in patients with resectable disease at diagnosis.Neoadjuvant strategies in resectable,borderline resectable,or locally advanced pancreatic cancer may improve outcomes.Incorporation of tissue biomarker testing and imaging techniques into preoperative strategies should allow clinicians to identify patients who may ultimately achieve curative benefit from surgery.This review summarizes current knowledge of adjuvant and neoadjuvant treatment for PDAC and discusses the rationale for moving from adjuvant to preoperative and perioperative therapeutic strategies in the current era of more active chemotherapies and personalized medicine.We also discuss the integration of good specimen collection,tissue biomarkers,and imaging tools into newly designed preoperative and perioperative strategies.

TTF-1 positive small cell cancers:Don't think they're always primary pulmonary!

Thyroid transcription factor 1 (TTF-1) plays a key role in morphogenesis of the lungs and is expressed in up to 90% of pulmonary small cell carcinomas.This explains why this marker is frequently used in the search for the primary origin of metastatic endocrine tumours.Here we report on a TTF-1 expressing mixed endocrine-exocrine carcinoma of the common bile duct in a patient with pulmonary nodules that did not appear to be neoplastic.TTF-1 positivity in pulmonary and extrapulmonary neuroendocrine tumours is reviewed,and we conclude that TTF-1 expression in neuroendocrine tumours of the small-cell type are not uncommon at extrapulmonary locations.Therefore,immunohistochem-istry for TTF-1 in such tumours should be interpreted with caution.

Limited influences of chemotherapy on healthy and metastatic liver parenchyma

AIM: To examine the expression of E-cadherin, β-catenin,γ-catenin, VEGF, and p53 in 39 patients with hepatic metastasis from colorectal cancer immunohistochemically.METHODS: The patients were divided into two groups:those (n = 16) who had no chemotherapy for at least 6 mo before the liver resections and those (n = 23)who were treated with chemotherapy before liver resections. A score from 0 to 3 was given for the number of positive cells and from 0 to 3 for the intensity of staining in these cells, in both healthy and metastatic liver parenchyma.RESULTS: No significant differences in the expression of E-cadherin, β- and γ-catenin, VEGF and p53, could be observed between patients who received and did not receive chemotherapy, in both normal and metastatic liver parenchyma.CONCLUSION: Despite the assumption that chemotherapy had an effect on liver metastasis, no influences were noticed immunohistochemically.