Outline+Draft

Presentation Outline

-Pancreatic cancer is the fourth leading cause of death -2009 Projected Statistics: 42,470 cases, with 35,240 deaths -Future outlook: Pancreatic cancer is expected to increase 55% in annual cases reported by 2030 with aging population US recommends against asymptomatic screening. -CA19-9 Marker -EUS -CT scans -ERCP -Abdominal masses -PET -MRI Demographic Recommendations -All Tests -Small percent of overall population, need to down to high risk -Older population, African American, Smokers, Obese Population -Antigen secreted by malignant pancreatic cells -Also secreted by normal bile duct, gallbladder and stomach cells -Relatively specific test, around 75% specific, however it produces many false positives, giving sensitivity close to 80% -Best results shown in patients with stage 2 or 3 (PanIN-2, -3 lesions), quite advanced and already almost cancer -Endoscopic ultrasound utilizes oral or rectal insertion of a flexible tube with a transducer (sends sound waves into the body and converts sound waves returning at different times and speeds to visual images) -Take pictures of the pancreas. Identify dense masses in the pancreas 2-3mm in diameter -Up to 90% sensitive and 95% specific with contrast-enhanced power mode. -Observance of lesions are up to the observer, therefore detected masses may be passed up on a case by case basis -Cancer prevalent in only a small percentage of the population. Not effective to screen everyone -Screen in high risk patients: people over the age of 60 (87% of all pancreatic cancer cases), people with onset diabetes (which may also be a symptom of pancreatic cancer), African American (50% greater chance than any other race), Ashkenazi Jewish ancestry, chronic pancreatitis, smoking -Current screening methods are implemented only when symptoms are prevalent. Resection rate and recovery rate in these patients is low as cancer is most likely metastasized. -PAM4 -Spyglass -PAM4 is an antibody which reacts to MUC1, a protein secreted in malignant cells of the pancreas. Radio-imaging can detect even stage 1A lesions, the earliest pancreatic cancer indicators. Specificity of 95% with a sensitivity of 77%. -Sensitivity can be further increased with an antitumor antibody injection beforehand, streptavidin or bsMAb) giving brighter tumors on the image. -Radio-imaging can be complemented with serologic tests of PAM4 concentrations. If blood concentration is almost gone, as removed by the kidneys, and bright spots still visible 4-7 days after initial test in the pancreas, tumors are almost always present. -Catheter based endoscope: visual inspections had 100% sensitivity and 77% specificity. -Used for screening and treatment: biopsy with end of wire -? -No one method is the ultimate method that will diagnose pancreatic cancer 100% of the time -People are different, and bodies work differently, so as scientists we must work to cover the greatest majority of the population with a very sensitive test. -Future tests are more likely to contain biological markers, which as of now, are hard to detect with current imaging techniques.
 * Introduction**:
 * Current Methods:**
 * Find specificity and sensitivity for all
 * Take on test and find 2 sources. List advantages and disadvantages. Email to Rachel or Radu by SATURDAY! **
 * Screening Template
 * What is it?
 * How does it work?
 * How early does it detect?
 * Advantages/Disadvantages
 * Statistics
 * Sensitivity
 * Specificity
 * Usage
 * Extras
 * Invasiveness
 * Dangers
 * Conclusion- Recommendations
 * CA19-9:**
 * EUS:**
 * Population screening:**
 * Future Screening:**
 * PAM4:**
 * Spyglass**:
 * Conclusion**:

Introduction-1 Current Tests-1 (EUS-3) (Graph/Chart-1) Future Tests-2 Demographics-2 (Baseline bar graph) Recommendations-2

-Demographics: use genetic information and age for recommendations (ignore age)