Unregistered User If this is not your name, click here.
		Contact Us | Order Now | Journals | Bookstore | Register a colleague
	Select a ChannelAcneAIDS and HIVAllergy OtherAlzheimer'sAnaesthesiology OtherAngina Pectoris/MIAnxietyArthritis OtherAsthmaBack PainBacterial InfectionsBladder CancerBone Marrow TransplantationBreast CancerCardiology OtherCataractCell TransplantationCervical CancerCholesterol/Lipid disordersCirrhosisClinical PharmacologyColorectal CancerCongestive Heart FailureContact DermatitisContraceptionCOPDCystic FibrosisDental and Oral DisordersDepressionDermatology OtherDiabetesDialysisEating DisordersElbowEmergency MedicineEndocrinology OtherEpilepsyErectile DysfunctionFibromyalgiaGastro OtherGeneticsGenitourinary OtherGeriatricsGERD/GastritisGlaucomaH. Pylori/UlcerHaematology OtherHair LossHeadachesHepa/Biliary OtherHepatitisHipHRTHypertensionIBDImmunologyInfectious OtherInfertilityIntensive CareIrritable Bowel SyndromeKneeLeukemiasLiver CancerLung CancerLupusLymphomasMelanomaMenopauseMultiple Sclerosis Nephrology OtherNeurologic OtherNutritional / Metabolic OtherOb/Gyn OtherObesityOncology OtherOphth. OtherOphthalmic SurgeryOrgan TransplantationOrthopaedics OtherOsteoarthritisOsteoporosisOtitisOtorhino. OtherOvarian CancerPaediatricsPainPancreatic CancerParkinson'sPregnancyProstate CancerPsychiatry OtherPulmonary OtherRadiologyRenal CancerRenal FailureRespiratory InfectionsRheumatoid arthritisRheumatology OtherRhinitisSchizophreniaShoulderSleep ApnoeaSleep DisordersSpineStrokeSTDsSurgeryThyroid DisordersTransfusionTransplant Surgery OtherTraumaUrinary IncontinenceUrinary tract infectionsVaccinologyVascular DisordersViral Infections

SEARCH   News Bookstore Medline The Web Meetings & Congresses Complete Doctor's Guide    EXPLORE :    All News   All Webcasts   All Cases   All Meetings & Congresses   All Medical Resources New drugs / indications English Dictionary Medical Dictionary Thesaurus Warning | Privacy | Awards  Favourite Journals  Click here to choose your favourite journals  Favourite Sites  Click here to choose your favourite sites  Languages  Select languageEnglishFrançais

New Tool Can Help Guide Pancreatic Cyst Treatment LOS ANGELES -- February 24, 2010 -- As a result of improved imaging technology, pancreatic cysts are increasingly diagnosed in asymptomatic individuals who undergo scans for other reasons. And while most of these cysts follow a benign course, a small but significant number are either malignant at the time of diagnosis or have the potential to develop into pancreatic cancer during a patient’s lifetime. The dilemma for both patient and clinician is determining which cysts to leave alone and which to surgically remove. Existing treatment guidelines don’t clearly address many treatment options beyond the removal of part of the pancreas -- a major undertaking for an asymptomatic lesion. Now, a research team has developed an evaluation tool to help guide asymptomatic pancreatic cyst treatment. Published in the February issue of the journal Gastroenterology, the tool takes into account overall health, age, cyst size, surgical risk, and patients’ views about quality of life. “Surgery may not be the best initial approach for all patients diagnosed with a specific pancreatic cyst,” said study author Brennan Spiegel, MD, University of California Los Angeles (UCLA) VA Center for Outcomes Research and Education, and the David Geffen School of Medicine, Los Angeles, California. “The new tool may help with decision-making and mapping out a treatment plan.” The diagnosis of asymptomatic cysts has increased 5-fold over the past decade, due partly to an aging population and to improved diagnostics. Current imaging techniques -- including computed tomography (CT), magnetic resonance imaging (MRI) and endoscopic ultrasound, combined with pancreatic cyst fluid analysis, offer a 80% accuracy in cyst diagnosis. “Pancreatic cysts are most often diagnosed in an older population, and although many are benign, these must be carefully tracked, since a small percentage can develop into pancreatic cancer,” said co-author James J. Farrell, MD, at the Geffen School of Medicine and UCLA’s Pancreatic Diseases Program. Using decision-analysis software, the research team evaluated a set of hypothetical patients ranging in age from 65 to 85 years with a variety of asymptomatic pancreatic cysts, ranging in size from half a centimeter to greater than 3 cm and located in the head of the pancreas, the most common site for branch duct cysts. The evaluation tool compared four competing treatment strategies: surgical removal of the cyst, annual non-invasive imaging surveillance with MRI or CT, annual endoscopic ultrasound, and no treatment. While the tool takes into account patient age, health, cyst size, and surgical risk, it also considers whether the patient values overall survival, no matter the quality of life, or if he or she prefers balancing quantity and quality of life by pursuing less invasive medical measures, which may lead to shorter survival but a better quality of life. The researchers found that to maximise overall survival, regardless of the quality of life, surgical removal was the dominant strategy for a cyst >2 cm, despite the patient’s age or other health issues -- this is smaller than the 3 cm threshold supported by current treatment guidelines for surgical intervention. Surveillance was the dominant strategy for any cyst <1 cm, which is similar to current guidelines. For patients focused on optimising both quantity and quality of life, either the “do nothing” approach or surveillance strategy appeared optimal for those aged 65 to 75 years with cysts <3 cm. For patients aged over 85 years, non-invasive surveillance dominated if quality of life was important, most likely because surgical benefits are often outweighed by the poor quality of life experienced post-operatively in this population. The researchers noted that data and information on how to use the new evaluation tool are available in the study manuscript, and that the tool is ready for use by clinicians. Future research aimed at further understanding the disease process, exploring the rate at which benign cysts turn malignant, and delineating the natural history of a malignant cyst that doesn’t undergo treatment may also help improve management of pancreatic cysts, the researchers said. SOURCE: University of California at Los Angeles E-mail this page to a friend or colleague! To print, use this version