Combating (pre) malignant pancreatic disease

This thesis focuses on the early detection of potentially malignant cysts in the pancreas. Pancreatic cysts can be roughly divided into two groups - benign cysts, and neoplastic cysts (PCN), which have the potential to degenerate into cancer, and is regularly removed by means of surgery. But even within the PCN we can distinguish different types, each with its own risk for malignancy. In this thesis we show that it is still difficult to distinguish between low risk and high risk PCN, exposing patients with low risk PCN to unnecessary surgery. We therefore explored a few molecular markers in pancreatic cyst fluid for the detection of high risk PCN eligible for surgery. Furthermore, we show that the activation of the endocannabinoid system has an immunomodulating effect in chronic pancreatitis patients through inhibition of the mTOR kinase. Finally, we have looked at whether treatment with inhibitors of the mTOR kinase is an option in some patients that have developed pancreatic cancer.