Pancreatic Adenocarcinoma Clinical Trial
Official title:
Detection of Circulating Tumor Cells for the Diagnostic of Pancreatic Adenocarcinoma.
Histological proof is a crucial and necessary step for appropriate care in oncology. In the
case of pancreatic cancer, histological proof from pathological analysis of the surgical
specimen is very rare due to the limited number (15-20 %) of localized tumor accessible to
surgical resection. In most cases, invasive endoscopic explorations are necessary for
histological diagnosis before deciding of the most appropriate treatment (palliative
chemotherapy or radiochemotherapy). The endoscopic ultrasound with fine needle aspiration
(EUS-FNA) is currently considered as the first-line endoscopic procedure for the cytological
diagnosis of solid pancreatic tumors. The technique is performed under general anesthesia
with sensitivity for the diagnosis of adenocarcinoma of 80% in case of a single procedure and
92% in situations where three different procedures are required. EUS-FNA has to be performed
by a physician properly trained for this type of interventional endoscopy. Some severe
complications may occur but are relatively rare in expert centers (bleeding, perforation,
complications of general anesthesia ...).
Diagnostic alternative approach is biological with research in the peripheral blood of
markers of tumor disease. It is possible to detect indirect markers which are molecules
produced by tumor tissue (eg CA19.9) and direct markers which reflect the presence of tumor
biological material (circulating tumor cells (CTCs) or circulating tumor DNA).
The value of detection of CTCs is not determined for the diagnostic and therapeutic
management of pancreatic cancer. Indeed, no study has evaluated the diagnosis performance of
circulating markers with EUS-FNA, the reference method for the diagnosis of unresectable
forms.
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