Detection of Pancreatic Cancer and Precancer by Stool DNA Testing: A Feasibility Study
Recently, advances in DNA-based stool tests have made it possible to detect another type of cancer — colorectal neoplasia. Given these exciting advances, we are currently studying the effectiveness of DNA-based stool tests for the detection of pancreatic cancer and its precursor, intraductal papillary mucinous neoplasms (IPMN) in collaboration with Dr. David Ahlquist's group at the Mayo Clinic.
Molecular Genetics and Epidemiology of Pancreatic Cancer
The primary aim of this study is to determine the combined frequency of BRCA1 and BRCA2 mutations in both Ashkenazi Jewish pancreatic cancer patients and across all pancreatic cancer patients. Patients with BRCA1/BRCA2 mutations will be compared to BRCA1/BRCA2 negative pancreatic cancer control patients to determine clinical and pathological features specific to BRCA1/BRCA2 positive tumors. Genetic studies such as this may ultimately lead to improved pancreas cancer screening and early detection, as well as new treatments for pancreas cancer.
Utility of [18F]-FDG PET Imaging to Distinguish Malignant from Benign Intrapapillary Mucinous Neoplasms (IPMN)
An accurate, non-invasive method to identify malignant IPMN is needed, as endoscopic ultrasounds are invasive and operator-dependent. PET/CT is already being utilized in the utility, management, and follow-up surveillance of pancreatic adenocarcinoma. Therefore, we are hypothesizing that PET/CT will also be an effective method for distinguishing malignant from benign IPMN.
Pancreatic Cancer in Minorities
Through this project we are planning to evaluate minority patients affected by pancreatic cancer that carry genetic mutations that have been previously linked to the disease in familial studies, and those potentially at high risk of developing the disease based on family history. We are also going to study clinical characteristics such as age and stage of the disease at the time of presentation, treatment choices such as referral to surgery, chemotherapy or radiation therapy, and presence of other risk factors such as obesity, diabetes and smoking.
MRI with Secretin Enhancement to Increase Conspicuity of Pancreatic Cancer
In the current study, secretin-enhanced MRI (SMRI) will be utilized to assess whether or not secretin increases the ability to clearly discern a tumor. It is thought that since secretin increases blood flow to the normal pancreas, areas of dysplasia/cancer where there is minimal blood flow, will become more visible, that is tumor conspicuity will increase. While secretin's effect on tumor visualization has been studied using CT, it will be important to look at secretin's effect on MRI as imaging facilities have recently turned to MRI for visualizing small pancreatic lesions and for better visualization of the entire pancreas and the pancreatic duct.
Pancreatic Cancer Registry and Tissue Bank for High Risk Individuals
The specific aims of this project are to create a registry, as well as a blood and a tissue bank for individuals with and at high risk for pancreatic cancer. Therefore, no hypothesis is to be tested. The personal data derived from the registry, correlated with biological information derived from the tissue specimens will allow for future investigative studies of pancreatic cancer etiology and tumor biology. The long term goals of the study are to advance the knowledge of the etiology and epidemiology of pancreatic cancer.
Family and Personal History of Malignancies in Patients with Intraductal Papillary Mucinous Neoplasms
In this retrospective study, we are interested in assessing the proportion of patients who reported a self history and/or family history of pancreatic cancer and other malignancies. In addition, we will determine if patients with a familial history seem to have a higher frequency of more aggressive anatomic subtypes (main or mixed type versus branch type) and histology (carcinoma in situ or invasive carcinoma). Finally, we will assess if patients with familial history are more likely to have recurrence of invasive carcinoma following surgical resection.
Pancreatic Intrapithelial Neoplasia (PanIN) and the Association with Recurrence of Pancreatic Adenocarinoma
Our focus for this retrospective study is studying patients with recurrent localized pancreatic cancer following surgical resection for pancreatic adenocarcinoma. In particular, we would like to compare the frequency of PanIN lesions in recurrent patients, in comparison to those that did not recur. Secondly, we are interested in studying if the characteristics of PanIN lesions multifocality, size, distance from the invasive tumor are significantly different in recurrent patients.
Local Invasion of Pancreatic Cancer
We 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, as well as the frequency of recurrence. We also believe that we would be able to gain a better understanding of whether preoperative staging by the TNM system, based on imaging, is consistent with postoperative staging based on pathology.