| Title: |
Ampullary cancer of intestinal origin and duodenal cancer - A logical clinical and therapeutic subgroup in periampullary cancer |
| Authors: |
Chandrasegaram, MD; Gill, AJ; Samra, J; Price, T; Chen, J; Fawcett, J; Merrett, ND |
| Source: |
urn:ISSN:1948-5204 ; World Journal of Gastrointestinal Oncology, 9, 10, 407-415 |
| Publisher Information: |
Baishideng Publishing Group |
| Publication Year: |
2017 |
| Collection: |
UNSW Sydney (The University of New South Wales): UNSWorks |
| Subject Terms: |
32 Biomedical and Clinical Sciences; 3211 Oncology and Carcinogenesis; Rare Diseases; Clinical Research; Clinical Trials and Supportive Activities; Orphan Drug; Pancreatic Cancer; Digestive Diseases; Cancer; 2.1 Biological and endogenous factors; Ampullary cancer; Chemotherapy; Duodenal cancer; Epidermal growth factor receptor; Intestinal subtype; KRAS; Pancreaticoduodenectomy; Pancreatobiliary subtype; Periampullary cancer; anzsrc-for: 32 Biomedical and Clinical Sciences; anzsrc-for: 3211 Oncology and Carcinogenesis |
| Description: |
Periampullary cancers include pancreatic, ampullary, biliary and duodenal cancers. At presentation, the majority of periampullary tumours have grown to involve the pancreas, bile duct, ampulla and duodenum. This can result in difficulty in defining the primary site of origin in all but the smallest tumors due to anatomical proximity and architectural distortion. This has led to variation in the reported proportions of resected periampullary cancers. Pancreatic cancer is the most common cancer resected with a pancreaticoduodenectomy followed by ampullary (16%-50%), bile duct (5%-39%), and duodenal cancer (3%-17%). Patients with resected duodenal and ampullary cancers have a better reported median survival (29-47 mo and 22-54 mo) compared to pancreatic cancer (13-19 mo). The poorer survival with pancreatic cancer relates to differences in tumour characteristics such as a higher incidence of nodal, neural and vascular invasion. While small ampullary cancers can present early with biliary obstruction, pancreatic cancers need to reach a certain size before biliary obstruction ensues. This larger size at presentation contributes to a higher incidence of resection margin involvement in pancreatic cancer. Ampullary cancers can be subdivided into intestinal or pancreatobiliary subtype cancers with histomolecular staining. This avoids relying on histomorphology alone, as even some poorly differentiated cancers preserve the histomolecular profile of their mucosa of origin. Histomolecular profiling is superior to anatomic location in prognosticating survival. Ampullary cancers of intestinal subtype and duodenal cancers are similar in their intestinal origin and form a logical clinical and therapeutic subgroup of periampullary cancers. They respond to 5-FU based chemotherapeutic regimens such as capecitabine-oxaliplatin. Unlike pancreatic cancers, KRAS mutation occurs in only approximately a third of ampullary and duodenal cancers. Future clinical trials should group ampullary cancers of intestinal origin and duodenal ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
unknown |
| Relation: |
https://hdl.handle.net/1959.4/unsworks_53879; https://doi.org/10.4251/wjgo.v9.i10.407 |
| DOI: |
10.4251/wjgo.v9.i10.407 |
| Availability: |
https://hdl.handle.net/1959.4/unsworks_53879; https://unsworks.unsw.edu.au/bitstreams/2ea948b9-c007-440f-847d-1f789eb85a70/download; https://doi.org/10.4251/wjgo.v9.i10.407 |
| Rights: |
open access ; https://purl.org/coar/access_right/c_abf2 ; CC BY-NC ; https://creativecommons.org/licenses/by-nc/4.0/ ; free_to_read |
| Accession Number: |
edsbas.24533059 |
| Database: |
BASE |