Wednesday, January 4, 2012

Chromogranin A :The Test

Chromogranin A test is a tumor marker.  The oncologist may order this test along with other tests if they suspect a carcinoid tumor,pheochromocytoma, and neurendocrine tumor.

Carcinoid tumor are derived from primitive stem cells in the gut wall but can be seen in other organs,[1] including the lungs,[2] mediastinum, thymus,[3] liver, pancreas, bronchus, ovaries,[4] prostate,[5] and kidneys.[6] In children, most tumors occur in the appendix and are benign and asymptomatic.
Most carcinoid tumors are slow growing and indolent without symptoms. Nevertheless, aggressive and metastatic disease (eg, to the brain) does occur. Even tumors in the appendix can metastasize.[7, 8] Depending on the size and location, carcinoid tumors can cause various symptoms, including carcinoid syndrome. Carcinoid tumors of the ileum and jejunum, especially those larger than 1 cm, are most prone to produce this syndrome, at least in adults.

Pheochromocytoma is a neuroendocrine tumor of the medulla of the adrenal glands (originating in the chromaffin cells), or extra-adrenal chromaffin tissue that failed to involute after birth [1] and secretes excessive amounts of catecholamines, usually noradrenaline (norepinephrine), and adrenaline (epinephrine) to a lesser extent.[2] Extra-adrenal paragangliomas (often described as extra-adrenal pheochromocytomas) are closely related, though less common, tumors that originate in the ganglia of the sympathetic nervous system and are named based upon the primary anatomical site of origin.

Neuroendocrine tumors (NETs) are neoplasms that arise from cells of the endocrine (hormonal) and nervous systems. Many are benign, while some are cancers. They most commonly occur in the intestine, but are also found in the lung and the rest of the body.
Although there are many kinds of NETs, they are treated as a group of tissue because the cells of these neoplasms share common features, such as looking similar, having special secretory granules, and often producing biogenic amines and polypeptide hormones.[1]

The Chromogranin A  may be ordered in combination with or in place of 5-HIAA to help diagnose carcinoid tumors. It is also used to help monitor the effectiveness of treatment and detect recurrence of this tumor. Sometimes it may be ordered with specific hormones, such as catecholamines, to help diagnose and monitor a pheochromocytoma. It may also be used to detect the presence of other neuroendocrine tumors, even those that do not secrete hormones.

Chromogranin A concentrations are normally low.  An increased level in a symptomatic person may indicate the presence of a tumor but will not tell the doctor what type it is or where it is. The quantity of CgA is not associated with the severity of a person's symptoms but is associated with the tumor burden - the mass of the tumor.
If concentrations of CgA are elevated prior to treatment and then fall, then treatment is likely to have been effective. If monitored levels begin to rise, then the person may have a recurrence of the tumor.

For more information,,

Tuesday, January 3, 2012

Pancreatic Cancer

Pancreatic cancer is an adenocarcinoma . Adenocarcinoma is a cancer of the epithelium but begins in the glandular tissue.  Epithelium is the tissue the is the layer that is in our skin ,glands and is in the tissue lining that covers our major organs. For cancer to be diagnosed an adenocarcinoma it does not have to be a part of a gland but have excretory properties. It is easier to determine adenocarcinoma if the tissue resembles the tissue from which the tissue from which the glandular tissue it came from.  Some adenocarcinoma is difficult to know if determine so there must be a biopsy in which the pathologist through staining procedures determine the diagnosis. As long as the cells of the tissue have and exocrine characteristic then it is considered glandular and therefore is malignant.

Above it an image of pancreatic cancer. Inside are the tumors that were determined by the pathologists and radiologists.

Above is tissue that has been processed by histology and this view is what is seen by the pathologist under the microscope.  This image was taken by cure byte.  This was used to diagnosed adenocarcinoma pancreas.

This is a video by Dr.Mark Fraiman explaining Pancreatic cancer.
Pancreatic cancer is highly lethal.  It is hard to diagnosed and usually cannot be diagnosed until later in the course of the disease.

The conditions that may put people at risk include tobacco use, obesity, a sedentary lifestyle, a history of diabetes, chronic pancreatic inflammation (pancreatitis), and a fatty (or Western) diet. Prior stomach surgery may moderately increase one's risk as can certain chronic infections such as hepatitis B and H. pylori (an infection of the stomach lining). Certain types of pancreatic cysts may put individuals at risk of developing pancreatic cancer. Despite these associated risks, no identifiable cause is found in most people who develop pancreatic cancer.

The tests for diagnosis of Pancreatic Cancer are the following:

  • Ultrasound. Ultrasound uses high-frequency sound waves to create moving images of your internal organs, including your pancreas. The ultrasound sensor (transducer) is placed on your upper abdomen to obtain images.
  • Computerized tomography (CT) scan. CT scan uses X-ray images to help your doctor visualize your internal organs. In some cases you may receive an injection of dye into a vein in your arm to help highlight the areas your doctor wants to see.
  • Magnetic resonance imaging (MRI). MRI uses a powerful magnetic field and radio waves to create images of your pancreas.
  • Endoscopic retrograde cholangiopancreatography (ERCP). This procedure uses a dye to highlight the bile ducts in your pancreas. During ERCP, a thin, flexible tube (endoscope) is gently passed down your throat, through your stomach and into the upper part of your small intestine. Air is used to inflate your intestinal tract so that your doctor can more easily see the openings of your pancreatic and bile ducts. A dye is then injected into the ducts through a small hollow tube (catheter) that's passed through the endoscope. Finally, X-rays are taken of
  • Endoscopic ultrasound (EUS). EUS uses an ultrasound device to make images of your pancreas from inside your abdomen. The ultrasound device is passed through an endoscope into your stomach in order to obtain the images. Your doctor may also collect a sample of cells (biopsy) during EUS.
  • Percutaneous transhepatic cholangiography (PTC). PTC uses a dye to highlight the bile ducts in your liver. Your doctor carefully inserts a thin needle into your liver and injects the dye into the bile ducts. A special X-ray machine (fluoroscope) tracks the dye as it moves through the ducts.
  • Removing a tissue sample for testing (biopsy). A biopsy is a procedure to remove a small sample of tissue from the pancreas for examination under a microscope. A biopsy sample can be obtained by inserting a needle through your skin and into your pancreas (fine-needle aspiration). Or it can be done using endoscopic ultrasound to guide special tools into your pancreas where a sample of cells can be obtained for testing.
  • the ducts. A tissue or cell sample (biopsy) can be collected during ERCP.

What is the treatment for locally advanced unresectable pancreatic cancer?

If a pancreatic cancer is found when it has grown into important local structures but not yet spread to distant sites, this is described as locally advanced unresectable pancreatic cancer (stage III). The standard of care in the United States for the treatment of locally advanced cancer is a combination of low-dose chemotherapy given simultaneously with radiation treatments to the pancreas and surrounding tissues. Radiation treatments are designed to lower the risk of local growth of the cancer, thereby minimizing the symptoms that local progression causes (back or belly pain, nausea, loss of appetite, intestinal blockage, jaundice). Radiation treatments are typically given Monday through Friday for about five weeks. Chemotherapy given concurrently (at the same time) may improve the effectiveness of the radiation and may lower the risk for cancer spread outside the area where the radiation is delivered. When the radiation is completed and the patient has recovered, more chemotherapy is often recommended. Recently, newer forms of radiation delivery (stereotactic radiosurgery, gamma knife radiation, cyberknife radiation) have been utilized in locally advanced pancreatic cancer with varying degrees of success, but these treatments can be more toxic and are, for now, largely experimental.

What is the treatment for metastatic pancreatic cancer?

Once a pancreatic cancer has spread beyond the vicinity of the pancreas and involves other organs, it has become a problem through the system. As a result, a systemic treatment is most appropriate and chemotherapy is recommended.

For more information or