University of Colorado Cancer Center member Marco Del Chiaro, MD, PhD, division chief of surgical oncology, is coordinating a new effort to standardize global diagnosis and treatment efforts for cystic tumor of the pancreas. More frequent than solid lesions, cystic tumors are usually detected incidentally and are often asymptomatic.
“It is estimated by prospective studies that the prevalence in the general population of cystic lesion of the pancreas is 50%,” Del Chiaro says. “Most of those lesions are detected during a scan for other reasons; let’s say you fall down the stairs and go to the emergency room and they give you a CT scan, and in the scan, you see a cyst. That’s the first problem: ‘What do we do now?’ It’s very difficult to make a differential diagnosis. Some of those cysts can progress to pancreas cancer, and of some of them are completely benign and never evolve.”
Original guidance
Del Chiaro led the development of other guidelines for cystic tumors of the pancreas in Europe in 2011 and has regularly updated them since then. He led publication of the 2018 paper “European evidence-based guidelines on pancreatic cystic neoplasms,” a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy.
In that report, European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics, including biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm, mucinous cystic neoplasm, serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology. Recommendations included conservative management and relative and absolute indications for surgery.
Clearing confusion
Del Chiaro, along with four other international leaders in the field, launched the new standardization effort in May, at the annual meeting of the Pancreas Club in Chicago. He has heard from several major pancreatic groups around the globe since then that are looking to join the effort and put an end to the current state of guidance for the condition, which consists of several sets of guidelines from different societies, some of which are in conflict with one another.
“That creates a lot of confusion, especially for people who are not experts in the area,” Del Chiaro says. “One guideline says you need to do surgery; another one says you don’t need surgery. One guideline says to stop surveillance; another one says you should continue surveillance. I convinced the majority of major societies, especially the ones that produce the most important guidelines, to join together and create this report. It would be impossible to involve all the societies of the world, but we tried to get together the major actors and make the process a little more clear.”
Leading the way
Del Chiaro says the effort, which he estimates will take two to three years to complete, is an indication of the CU Cancer Center’s place in the pancreatic cancer world.
“There has been more and more evidence over the past few years that we are one of the leading centers in this country and internationally for cancer of the pancreas.”
