The Sol Goldman Pancreatic Cancer Research Center

Advances and Discoveries Made at Johns Hopkins


Methylation of Precancers
Intraductal papillary mucinous neoplasms (IPMNs) can be a precursor to invasive pancreatic cancer. This is similar to colon polyps and colon cancer. Dr. Hong and colleagues from the Sol Goldman Pancreatic Cancer Research Center studied the methylation (addition of an extra carbon to certain parts of the DNA) patterns in a series of IPMNs. They found that some genes are abnormally methylated in IPMNs. This study not only adds to our understanding of the biology of IPMNs, but it also suggests that abnormal methylation markers may one day be useful in detecting IPMNs.

Reference:
Hong SM, Kelly D, Griffith M, Omura N, Li A, Li CP, Hruban RH, Goggins M. Multiple genes are hypermethylated in intraductal papillary mucinous neoplasms of the pancreas. Mod Pathol. 21:1499-507, 2008.


Sequencing Pancreatic Cancers
S. Jones and colleagues, in a real tour de force, sequenced all known human genes (the exomes) of a series of well-characterized pancreatic cancers. For the first time, scientists were able to define all of the major mutations (DNA changes) in pancreatic cancer. This can be thought of as learning the enemies "battle plans," or looking at the "blueprint" of how cancer works.

Reference:
Jones S, Zhang X, Parsons DW, Lin JC, Leary RJ, Angenendt P, Mankoo P, Carter H, Kamiyama H, Jimeno A, Hong SM, Fu B, Lin MT, Calhoun ES, Kamiyama M, Walter K, Nikolskaya T, Nikolsky Y, Hartigan J, Smith DR, Hidalgo M, Leach SD, Klein AP, Jaffee EM, Goggins M, Maitra A, Iacobuzio-Donahue C, Eshleman JR, Kern SE, Hruban RH, Karchin R, Papadopoulos N, Parmigiani G, Vogelstein B, Velculescu VE, Kinsler KW. Core signaling pathways in human pancreatic cancers revealed by Global Genomic Analyses. Science. 321:1801-6, 2008.


Pancreatic Cysts are Common
Precancerous lesions in the pancreas can form small cysts (fluid-filled collections) in the pancreas. Pancreatic cysts therefore represent an opportunity for early detection. Laffan and colleagues examined over 2,800 CT scans of patients without any known pancreatic problems. Remarkably, they found that 2.6% of asymptomatic individuals have a cyst in their pancreas. This suggests that screening for asymptomatic pancreatic cysts may one day be a viable approach to the early detection of precancerous lesions in the pancreas.

Reference:
Laffan TA, Horton KM, KleinAP, Fishman EK, Johnson PT, Hruban RH. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol 191: 802-7, 2008.


Multidisciplinary Clinic for Pancreatic Cancer
One of the first multidisciplinary (multi-D) clinics for the management of patients with pancreatic cancer was established here at Johns Hopkins in 2006. Dr. T. Pawlik and colleagues evaluated the care that patients received at the multi-D clinic and found that multidisciplinary clinics can have real impact. 25% (1 in 4) patients had a change in their recommended management based on clinical review of their case by the multidisciplinary tumor board. This study suggests that complex diseases such as pancreatic cancer are often best managed at specialized high-volume centers and by multi-disciplinary teams of experts.

Reference:
Pawlik T, Laheru D, Hruban RH, Coleman J, Wolfgang DL, Campbell K, Ali S, Fishman EK, Schulick RD, Herman JM, and the Johns Hopkins Multidisciplinary Pancreas Clinic Team. Evaluating the impact of a single-day multidisciplinary clinic on the management of pancreatic cancer. Ann Surg Oncol. 15:2081-8, 2008.