Professor, Pathology & Laboratory Medicine, Emory University School of Medicine
Director, Anatomic Pathology, Pathology & Laboratory Medicine, Emory University School of Medicine
Vice-Chair, Pathology & Laboratory Medicine, Emory University School of Medicine
Towards these purposes, I have focused on what is considered one of the most challenging organ groups in the body, the pancreatobiliary tract.
1) Pancreas cancer is the 4th leading cause of cancer deaths in the US. Currently, more Americans die of pancreas cancer than of prostate cancer, and it is estimated that in a few years, it will surpass breast cancer too in this regard. Its 5-year survival is < 5%. The reasons for the dismal prognosis of pancreas cancer are largely unraveled. I was a part of an international group of researchers who characterized the early steps of cancer formation in this organ, pancreatic intraepithelial neoplasia (PanINs). Later, we (my collaborators and I, including Dr. Ralph Hruban, Johns Hopkins University; and David Klimstra, Memorial Sloan-Kettering) have also shown that a distinct tumor type, intraductal papillary mucionous neoplasms, represent a different pathway of cancer formation in the pancreas, independent of PanINs. Our research in the past few years has mostly focused in this distinct pathway. Separately, we have identified other types of cancers that occur in the pancreas that are biologically and prognostically distinct from that of ordinary pancreas cancer, for example, colloid cancers, and the mechanisms that lead these tumors to behave far more favorably is likely to be important in solving the puzzles of carcinogenesis (cancer formation). We continue to investigate these cancers from both molecular, clinical and morphologic perspectives.
2) Ampulla of Vater is the region where pancreas and bile ducts adjoin the intestines. This is a small but complex area and the cancers of this region are poorly characterized, partly due to imprecise definition of this complex region. There has been a general impression that the prognosis of the cancers of the ampulla may somehow be better than those of the pancreas or bile ducts, but this impression had not been yet substantiated with careful pathologic analysis. Along with Drs. Ohike and Tajiri from Showa University, Japan, and collaborators from University of Pittsburgh as well as University of California at San Francisco, we performed the most detailed analysis of ampullary cancers based on the largest series to date, and have already discovered many facets of these cancers not previously recognized. Our recent studies have confirmed that ampullary cancers do indeed have a better prognosis than pancreas cancers overall, and we have also elucidated some of the reasons for this favorable outcome.
3) Gallbladder cancer is relatively less common than pancreas cancer in the US, but carries a similarly poor prognosis. Due to its relative rarity and the disinterest in this tumor type, gallbladder cancer is also poorly characterized pathologically. In Chile, gallbladder cancer is common and is the leading cause of cancer deaths among adult women. In our collaboration with J. C. Roa, Pontificia Universidad Catolica de Chile, Santiago, Chile; J. C. Araya, Universidad de La Frontera, Temuco, Chile; and K. T. Jang, Samsung Medical Center, Seoul Korea, we performed a detailed pathologic analysis of more than 600 primary invasive GB carcinomas, a huge undertaking, comprising the largest number of patients to date. In our ongoing studies, we defined the clinicopathologic characteristics of various types of gallbladder carcinomas such as mucinous and squamous cancers. Most importantly, we identified a distinct pathway of early cancer formation in this organ that we termed intracholecystic papillary tubular neoplasms, and we have made significant inroads into the characterization of these tumors, which will have major impact in our understanding of gallbladder carcinogenesis.
By all accounts, we have had yet another tremendously successful year working towards these goals.
Dr. Adsay, along with the Pancreatic Cancer Sequencing Team led by Dr. Ralph Hruban in the Sol Goldman Pancreatic Cancer Research Center at Johns Hopkins University, received the Seventh Annual AACR Team Science Award during the American Association for Cancer Research’s Annual Meeting 2013.
For more information on the Emory Team Collaborators, CLICK HERE.
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