LUND UNIVERSITY PO Box 117 221 00 Lund +46 46-222 00 00
Sex, hormonal factors and pancreatic cancer
Andersson, Gustav
2019
Document Version:
Publisher's PDF, also known as Version of record Link to publication
Citation for published version (APA):
Andersson, G. (2019). Sex, hormonal factors and pancreatic cancer. Lund University: Faculty of Medicine.
Total number of authors: 1
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G U ST A V A ND ERS SON Se x, h or m on al f ac to rs a nd p an cre ati c c an ce r
Lund University, Faculty of Medicine Doctoral Dissertation Series 2019:47 ISBN 978-91-7619-776-9 ISSN 1652-8220
Sex, hormonal factors and
pancreatic cancer
GUSTAV ANDERSSON
FACULTY OF MEDICINE | LUND UNIVERSITY
47
9
789176
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Table of Contents
Thesis at a glance ... 8List of papers ... 9
Abbreviations ... 10
Populärvetenskaplig sammanfattning ... 15
Introduction ... 19
Pancreatic cancer ... 19
Periampullary adenocarcinoma ... 19
Epidemiology ... 20
Worldwide ... 20
Low versus high income countries ... 20
Sweden ... 21
Aetiology ... 21
Endogenous risk factors ... 21
Exogenous risk factors ... 24
Other factors ... 26
Genetic alterations ... 27
Clinical presentation and diagnostics ... 28
Radiology ... 28
Biochemical markers ... 29
Clinicopathological factors ... 30
Tumour node metastasis ... 30
Differentiation grade ... 32
Invasion of the vascular and lymphatic system ... 32
Perineural growth and invasion of peripancreatic fat ... 32
Resection margins ... 32
Treatment ... 33
Surgical resection ... 33
Chemotherapy ... 34
Radiotherapy ... 37
Personalised treatment, targeted therapy and immunotherapy ... 38
Tamoxifen ... 38
Investigative biomarkers ... 43
Hormone receptors ... 43
Estrogen receptors ... 43
Progesterone receptors ... 44
The androgen receptor ... 45
Estrogen, progesterone and androgen receptors in pancreatic neoplasia ... 45
Aims of the thesis ... 47
Material and Methods ... 49
Patients ... 49
Cohort 1 ... 49
Cohort 2 ... 50
Cohort 3 ... 50
Investigative factors ... 51
Paper I ... 51
Paper II ... 51
Paper III ... 52
Paper IV ... 52
Tissue microarray (TMA) ... 53
Immunohistochemistry ... 54
Statistical analysis ... 54
Results and Discussion ... 57
Paper I ... 57
Paper II ... 58
Paper III ... 59
Paper IV and future perspectives ... 61
Strengths and Limitations ... 63
Conclusions ... 65
Acknowledgements ... 67
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