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PubMedDate not supplied

Bile duct cancer.

Bile duct cancer, although not among the common tumors, still accounts for more than 4,000 deaths a year in the United States. Clinicians caring for these patients are faced with difficulties in diagnosis, even with the best of modern imaging techniques, and if the tumor is not resectable (as is true for about 75 percent of all patients), the mean survival time is only a few months. Endoscopic diagnostic and therapeutic techniques have improved markedly. As with other malignant tumors, biliary cancer is best managed by a multidisciplinary team approach.

Aged↗
PubMed2005

Preoperative evaluation of pancreaticobiliary tumor using MR multi-imaging techniques.

AIM: To evaluate the clinical value of MR multi-imaging techniques in diagnosing and preoperative assessment of pancreaticobiliary tumor. METHODS: MR multi-imaging techniques, including MR cross-sectional imaging, MR cholangiopancreatography (MRCP) and 3D dynamic contrast-enhanced MR angiography (3D DCE MRA), were performed to make prospective diagnosis and preoperative evaluation in 28 patients with suspected pancreaticobiliary tumors. There were 17 cases of pancreatic adenocarcinoma, 8 cases of biliary system carcinoma and 3 cases of non-neoplastic lesions. RESULTS: Using MR multi-imaging techniques, the accuracy in diagnosing the patients with pancreaticobiliary tumors was 89.3% (25/28). The accuracy in detecting the range of tumor invasion was 80.3% (57/71). The sensitivity, specificity, accuracy, positive and negative predictive value of MR multi-imaging techniques in preoperative assessment of the resectability of pancreaticobiliary tumor were 83.3%, 89.5%, 88.0%, 71.4%, and 94.4%, respectively. There was well diagnostic consistency between MR multi-imaging techniques and CT (kappa = 0.64, P<0.01). The fusion image could be made from MRCP and 3D DCE MRA images. CONCLUSION: MR multi-imaging techniques can integrate the advantages of various MR images. The non-invasive "all-in-one" MR imaging protocol is the efficient method in diagnosing, staging and preoperative assessment of pancreaticobiliary tumor.

Adult↗
PubMed2006

One-step palliative treatment method for obstructive jaundice caused by unresectable malignancies by percutaneous transhepatic insertion of an expandable metallic stent.

AIM: To describe a simple one-step method involving percutaneous transhepatic insertion of an expandable metal stent (EMS) used in the treatment of obstructive jaundice caused by unresectable malignancies. METHODS: Fourteen patients diagnosed with obstructive jaundice due to unresectable malignancies were included in the study. The malignancies in these patients were a result of very advanced carcinoma or old age. Percutaneous transhepatic cholangiography was performed under ultrasonographic guidance. After a catheter with an inner metallic guide was advanced into the duodenum, an EMS was placed in the common bile duct, between a point 1 cm beyond the papilla of Vater and the entrance to the hepatic hilum. In cases where it was difficult to span the distance using just a single EMS, an additional stent was positioned. A drainage catheter was left in place to act as a hemostat. The catheter was removed after resolution of cholestasis and stent patency was confirmed 2 or 3 d post-procedure. RESULTS: One-step insertion of the EMS was achieved in all patients with a procedure mean time of 24.4 min. Out of the patients who required 2 EMS, 4 needed a procedure time exceeding 30 min. The mean time for removal of the catheter post-procedure was 2.3 d. All patients died of malignancy with a mean follow-up time of 7.8 mo. No stent-related complication or stent obstruction was encountered. CONCLUSIONS: One-step percutaneous transhepatic insertion of EMS is a simple procedure for resolving biliary obstruction and can effectively improve the patient's quality of life.

Aged↗
PubMed1999

Conformal irradiation for hepatobiliary malignancies.

The term 'conformal irradiation' is usually used to describe the delivery of sophisticated high dose external beam irradiation (EBRT) with the aid of 3-D treatment planning and the option of both coplanar and non-coplanar beams. Data will be presented from the University of Michigan which suggest that conformal high dose EBRT (48-72.6 Gy) can be used for intrahepatic cancers, both hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHCC), to potentially increase local control and survival over what would be expected with lower dose EBRT. For purpose of this discussion, the term conformal irradiation will be expanded to include other techniques which conform the high dose irradiation boost volume in close proximity to unresected tumor or positive margins of resection. Data will be presented from series which utilize transcatheter iridium and intraoperative electron irradiation (IOERT) supplements to EBRT +/- concomitant chemotherapy. Each method intensifies treatment in an attempt to improve local control and survival.

Bile Duct Neoplasms↗
PubMed1999

Diagnostic distinction between unusual malignant tumors of gall bladder by histochemistry and antigenic phenotype.

In a review of 79 cases of gall bladder malignancy, nineteen cases were labelled as unusual tumors while sixty were diagnosed as adenocarcinoma. Alcian blue, PAS, Grimelius' and Masson trichrome stains were done. Expression of EMA, CEA and desmin was assessed (PAP). Histological subtype was revised, in eleven cases out of 19. Five tumors initially diagnosed as squamous cell carcinoma were found to be positive for mucin and CEA and hence were reclassified as adenosquamous carcinoma. Three undifferentiated carcinomas and two malignant carcinoids were labelled as adenocarcinoma and composite tumor respectively. Positive reactivity with CEA and alcian blue PAS and absence of AFP helped in differentiating one giant cell carcinoma from hepatocellular carcinoma. No definite marker could be identified in one case of malignant mesenchymal tumor. Histochemistry and immunohistochemistry also helped in confirming the diagnosis of three cases of carcinoma in situ, one of malignant carcinoid and three of clear cell carcinoma.

Adult↗
PubMedDate not supplied

Polyurethane-covered Wallstents to recanalize Wallstents obstructed by tumor ingrowth from malignant common bile duct obstruction.

Four patients with malignant obstruction of the common bile duct had been treated with uncovered Wallstents and suffered from a reobstruction after 2-13 months (mean 5.3 months). Repeat cholangiography revealed severe stenosis of the stent lumen caused by tumor ingrowth through the mesh. A Wallstent with a self-made polyurethane-cover was inserted through the uncovered stent in these patients. The four patients were followed for 3-13 months (mean 6.3 months) until death. There was good drainage with no evidence of recurrent obstruction in all patients. We conclude that a covered Wallstent may extend patency of stented bile ducts, preventing tumor ingrowth in patients with neoplastic obstruction. Further observations are needed.

Aged↗
PubMedDate not supplied

Carcinoma of the extrahepatic biliary system: correlation of clinical, pathological, histological and DNA-cytometric parameters with prognosis.

BACKGROUND: Studies concerning the prognosis of all carcinomas of the extrahepatic biliary system together (EBC) do not exist, so far. A detailed and valid histopathological grading-system is lacking and the prognostic relevance of DNA-cytometric parameters is not clear. METHODS: 81 patients with EBC underwent surgical treatment. Clinical, pathological, histomorphological and DNA-cytometric parameters were evaluated. The influence on prognosis was tested in univariate and multivariate analysis. RESULTS: Apart from significant perioperative mortality (17%) survival was markedly dependent on the presence of tumor remnants in resection margins. After incomplete and complete resection, the median survival was 5 and 19 months, respectively (p < 0.0001). Further parameters with significant prognostic relevance were tumor localization, pTNM-stage, period of complaints, presence of gallstones, histological type and DNA-index. Multivariate analysis however demonstrated only two independent prognostic factors: status of resection margins and tumor localization. CONCLUSIONS: Histomorphological- and DNA-cytometric parameters failed to demonstrate an additional significant influence on the prognosis in EBCs. Apart from perioperative mortality, the survival of patients with EBC predominantly depends on tumor localization and the status of resection margins.

Adenocarcinoma↗
PubMed2000

The role of cyclooxygenase enzymes in the growth of human gall bladder cancer cells.

Information suggests that the cyclooxygenase (COX) metabolites, the prostanoids, play a role in gall bladder physiology and disease. Non-steroidal anti-inflammatory drugs which inhibit COX enzymes have been shown in vivo and in vitro to alter the growth patterns of intestinal epithelial cells, and specific COX-2 inhibitors have been shown to decrease mitogenesis in intestinal epithelial cells. The present study was intended to evaluate the effect of specific COX inhibitors on the growth patterns of gall bladder cancer cells. Employing a human gall bladder cancer cell line, mitogenesis, apoptosis and prostaglandin E(2) (PGE(2)) formation were evaluated in response to serum and hepatocyte growth factor and transforming growth factor alpha stimulation in the presence and absence of specific COX-1 and -2 inhibitors. The effect of the mitogens on COX enzyme expression was also evaluated. Serum and the growth factors increased COX enzyme expression and mitogenesis, and decreased apoptosis as evaluated by the percentage of cells that were floating in culture media rather than attached. There was more DNA degradation in floating than in attached cells. The specific COX-2 inhibitor, but not the COX-1 inhibitor, decreased mitogenesis and increased gall bladder cell apoptosis as evaluated by the number of floating versus attached cells and the number of floating cells in the terminal phase of apoptosis or dead. The inhibition of mitogenesis and the increased apoptosis produced by the COX-2 inhibitor was associated with decreased PGE(2) production. The inhibition of replication of gall bladder cancer cells and the increase in apoptosis produced by the selective COX-2 inhibitor suggests that the COX enzymes and the prostanoids may play a role in the development of gall bladder cancer and that the COX-2 inhibitors may have a therapeutic role in the prevention of gall bladder neoplasms.

Apoptosis↗
PubMedDate not supplied

A retrospective analysis of 88 patients with pancreaticogastrostomy after pancreaticoduodenectomy.

BACKGROUND/AIMS: Recently, pancreaticogastrostomy after pancreaticoduodenectomy has been reintroduced as a useful procedure with a low incidence of pancreatic leakage. We decided to retrospectively analyze the early postoperative and late follow-up complications in a large number of patients who had undergone our improved pancreaticogastrostomy. METHODOLOGY: Between August 1993 and November 1998, we performed pancreaticogastrostomy following pancreaticoduodenectomy in 88 consecutive patients including pylorus preservation in 14. Our pancreaticogastrostomy used a two-layer implantation method using a pancreatic duct stent with an anterior gastrotomy. RESULTS: The morbidity and mortality rates were 5.7% and 0%, respectively. There were no cases of pancreatic leakage and no postoperative complications directly related to the pancreaticogastrostomy. As for gastric emptying, the average time until resumption feeding was 12 days, with no significant difference between pancreaticogastrostomy and pylorus-preserving pancreaticogastrostomy. As to late follow-up complications, diabetes developed postoperatively in 6.5% (4/62) patients, and of 14 patients who were shown by magnetic resonance cholangiopancreatography, 5 (35.7%) developed pancreatic ductal dilatation after surgery. CONCLUSIONS: These results from a relatively large group conclusively prove the safety of pancreaticogastrostomy and indicate that the follow-up quality of life is good under the circumstances.

Anastomosis, Surgical↗
PubMed2001

[Clinical evaluation of hepatopancreatoduodenectomy].

The clinical outcome of hepatopancreatoduodenectomy (HPD) carried out in 14 patients in our institute was evaluated retrospectively. In principle, HPD is performed in patients with far-advanced biliary carcinoma extending from the level of the liver to pancreas directly or via metastatic lymph nodes around the head of the pancreas. However, the survival periods after surgery did not improve, contrary to expectations. Curative surgery was not achieved in most patients who underwent HPD, even if resection of the portal vein or hepatoduodenal ligament was performed during surgery. Severe lymphatic, vascular, and neural involvement along the hepatoduodenal ligament existed in those patients. In addition, it is possible that they already had micrometastases to other organs based on a study of the pattern of recurrence after surgery. Quality of life did not appear to improve unless the patients survived more than one year. These findings suggest that HPD may be appropriate for patients in earlier disease stages than those in our series to achieve longer survival. However, HPD is associated with high rates of postoperative complications and operative mortality, especially after pancreatoduodenectomy with liver resection involving more than right hepatectomy. We need to establish the appropriate indications for HPD and improve the safety of the procedure.

Aged↗
PubMedDate not supplied

Studies on biliary tract carcinoma in the case with pancreaticobiliary maljunction.

BACKGROUND/AIMS: The purpose of this study was to clarify the clinicopathological features of pancreaticobiliary maljunction and to determine the appropriate surgical approach for biliary tract with pancreaticobiliary maljunction. METHODOLOGY: The data of 77 patients with pancreaticobiliary maljunction including 13, who had been treated for biliary tract cancer, were reviewed retrospectively. We assessed the clinical features, biological characteristics of the cancer, methods of surgical treatment, postoperative outcome and cell proliferating activity of the biliary epithelium, evaluated by the PCNALI (proliferating cell nuclear antigen-labeling index). RESULTS: The incidence of cancer development in the case with pancreaticobiliary maljunction was 13.4% in the bile duct dilatation group (n = 67) and 40.0% in the non-dilatation group (n = 10). Dissection of lymphadenectomy was performed in 10 (76.9%) of 13 patients, and curative resection was feasible in 9 of the 10 patients. Two (20.0%) of the 10 patients had lymph node involvement noted at surgery and died of recurrence. In the other eight patients without lymph node involvement at surgery, six patients underwent curative resection and are alive at 7 months to 11 years and 6 months after surgery. PCNALI of the biliary epithelium of the patients with pancreaticobiliary maljunction was significantly higher than that of the control group. CONCLUSIONS: For patients with pancreaticobiliary maljunction, it should be stressed that the extrahepatic bile duct be prophylactically removed, even when there are no neoplasmatic changes because of high prevalence of cancer development, presumably predicted by the increase of cell proliferative activity in the biliary epithelium. For patients with biliary cancer, early detection at the stage with no lymph node involvement is essential to secure for long-term survival.

Adult↗
PubMed1975

Investigation of cell-vitality in tumor specimen after cryosurgical operations.

Carcinomas of the gastro-intestinal tract were resected in 6 patients either by cryosurgery or in the usual, conventional manner without freezing the tumor. Cells from the tumorsections in each case were isolated by the use of enzymes and were examined for vitality following trypan-blue vital staining. In 5 out of 6 cryosurgical cases fewer than 10% of the cells were vital compared with sections from nonfrozen specimen. In one case the freezing method (cryosurgery) did not have any influence on the cell vitality. The cell-damaging effect of cryosurgical procedures proven in vitro suggests possible additional therapeutic effects in tumor-patients. Cryosurgery has proven useful in the treatment of hypertrophic prostates, when an unusual risk was involved. Recently it has also been used in the surgical treatment of carcinomas of the skin, the bladder and the cervix (1; 2, 3, 6). Approximately a year ago we started to use cryosurgery in our hospital in inoperable abdominal tumors. After freezing the primary tumor or its metastases a massive breakdown of the remaining tumor in-situ occurs, which might produce a palliative effect. As a result of freezing the tumor before resection, we expect a decrease in the spread of tumor cells during surgery and a stimulation and mobilization of specific immune response against the tumor (5). In order to increase our knowledge of the biological behaviour of cryosurgically treated tumors, we investigated in the present study teh cell-vitality in tumor tissues before and after cryosurgery.

Cell Survival↗
PubMed2002

Cancer patterns in Karachi division (1998-1999).

OBJECTIVE: A minimal cancer incidence data for Karachi, the largest city of Pakistan, is being presented here, for the years 1998-1999. The city has a population of 9,802,134; males 5,261,712 (52.6%) and females 4,540,422 (47.4%); census 1998. METHODOLOGY: A predominantly mixed (passive and active) registration system has evolved in Karachi, the data sources being the hospitals within the Karachi Division. The reported/retrieved cancer data sets at the Karachi Cancer Registry are checked, coded, computerised in an analytical format and analysed. RESULTS: The incident cancer cases registered in Karachi, during the 2-year period, 1st January 1998 to 31st December 1999 were analysed. The age-standardised incidence rate (ASR) of cancer, all sites was 132.4/100,000 for the males. Cancer of the lung 10.8%; ASR 17.3 was the most frequently recorded malignancy, followed by oral cavity 10.5%; ASR 13.2 and larynx 5.0%; ASR 7.4. The age-standardised incidence rate (ASR) of cancer, all sites was 133.0/100,000 in the females. Cancer of the breast, 32.0%; ASR 40.7 was the most frequently recorded malignancy, followed by oral cavity 8.1%; ASR 11.7 and gall bladder 3.6%; ASR 5.5. CONCLUSION: The present data has been calculated with an estimated 15-20% probable under ascertainment. Tobacco-associated cancers in Karachi were responsible for 38.3% of the tumours diagnosed amongst the males. Two principal cancers, breast and oral cavity were responsible for 40.1% of the cancers in females. A rare finding was the high incidence of gall bladder cancer in the females. At present it is difficult to determine whether this indicates a genuine high risk or a selection bias. A continuous process of cancer registration to study the trends in the incidence and an adequate cancer control program are possible and essential for Pakistan and can be based on the pattern being practiced in Karachi.

Breast Neoplasms↗
PubMed2003

Phase II clinical trial of intralesional administration of the oncolytic adenovirus ONYX-015 in patients with hepatobiliary tumors with correlative p53 studies.

PURPOSE: ONYX-015 is a genetically modified adenovirus with a deletion of the E1B early gene and is therefore designed to replicate preferentially in p53-mutated cells. A Phase II trial of intralesional ONYX-015 was conducted in patients with hepatobiliary tumors to determine the safety and efficacy of such a treatment. EXPERIMENTAL DESIGN: All patients had biopsy-proven, measurable tumors of the liver, gall bladder, or bile ducts that were beyond the scope of surgical resection. Patients received intralesional injections of ONYX-015 at either 6 x 10(9) or 1 x 10(10) plaque-forming units/lesion up to a total dose of 3 x 10(10) plaque-forming units, and i.p. injections were allowed in patients with malignant ascites. The status of p53 was assessed by immunohistochemistry or Affymetrix GeneChip microarray analysis. Studies were conducted for viral shedding and for the presence of antiadenoviral antibodies before and after the injection of ONYX-015. Patients were assessed for response and toxicity. RESULTS: Twenty patients were enrolled, and 19 patients were eligible. Half of the patients had primary bile duct carcinomas. Serious toxicities (> grade 2) were uncommon and included hepatic toxicity (three patients), anemia (one patient), infection (one patient), and cardiac toxicity (one patient, atrial fibrillation). Sixteen patients were evaluable for response. Among these evaluable patients, 1 of 16 (6.3%) had a partial response, 1 of 16 (6.3%) had prolonged disease stabilization (49 weeks), and 8 of 16 (50%) had a >50% reduction in tumor markers. Of the 19 eligible patients, 18 (94.7%) had specimens available for p53 analysis. Fifteen of these 18 patients (83.3%) had evidence of p53 mutation by one or both methods, although the methods correlated poorly. Viral shedding was confined to bile (two of two patients) and ascites (four of four patients). Pretreatment adenoviral antibodies were present in 14 of 14 patients and increased by 33.2% after ONYX-015 treatment. CONCLUSIONS: Intralesional treatment with ONYX-015 in patients with hepatobiliary tumors is safe and well tolerated, and some patients had evidence of an anticancer effect. The high incidence of p53 mutations in these tumors makes this a logical population in which to test this therapy but precludes definitive evaluation about the necessity of a p53 mutation for ONYX-015 clinical activity.

Adenoviridae↗
PubMed1976

Adenocarcinoma in biliary papillomatosis.

A patient with multicentric biliary papillomatosis associated with invasive adenocarcinoma of the bile duct is reported. This case documents the progression to malignancy of a lesion generally thought to be benign. It serves to alert clinicians to a rare but important cause of recurrent biliary obstruction. The literature on this entity is reviewed.

Adenocarcinoma↗