Detecting Early Pancreatic Cancer: Problems and Prospects
Section snippets
Why Is Pancreatic Cancer Mortality so High?
One can identify three main reasons for the dismal prognosis of pancreatic cancer.
Definition(s) of Early Pancreatic Cancer
“Early” pancreatic cancer may be defined based on resectability, size or curability. Here are three definitions in order of decreasing prevalence and increasing survival (Fig 1).
Progression of Pancreatic Cancer From Pre-invasive Precursor to Unresectable Cancer
The now famous Vogelgram of pancreatic cancer proposed by Hruban et al12 plots the histologic and molecular progression of preinvasive stages of pancreatic cancer. However, not much is known about progression of invasive pancreatic cancer. We have tried to recreate, based on published literature, the natural history of pancreatic cancer from its preinvasive stage to its diagnosis and correlate it with symptoms and changes on cross-sectional imaging (Fig 2).
Timeline of Progression From Pre-invasive Precursor to Clinical Diagnosis of Pancreatic Cancer
Pancreatic cancer is frequently unresectable at diagnosis and rapidly fatal once the diagnosis is made. However, the timeline of progression from resectable to unresectable disease is not known. The earliest changes of high-grade dysplasia may appear many years before clinical diagnosis of cancer.16, 17 This is illustrated by the study in which atypical duct lesions preceded the diagnosis of infiltrating adenocarcinoma by 17 months, 9 years, and 10 years in three patients who had previously
Approaches to Screening for Early Pancreatic Cancer
Since sporadic pancreatic cancer patients seldom exhibit disease-specific symptoms until late in the course of the disease, detection of advanced stages of pre-invasive or early invasive pancreatic cancer will require screening asymptomatic patients for the disease. However, pancreatic cancer is relatively uncommon and it would not be cost-effective to screen for it in the general population. In a recent study it was observed that the pretest probability of dysplasia (or cancer) needs to be
Confirming the Diagnosis of Pancreatic Cancer
If noninvasive imaging is equivocal or negative, EUS will be necessary to conclusively diagnose pancreatic cancer. EUS uses high-frequency ultrasound probes placed in the stomach and duodenum juxtaposed to the pancreas, and can identify small pancreatic and periampullary tumors. EUS has exquisite sensitivity to detect tumors as small as 10 mm in size. It also has the capability of providing histologic confirmation of the diagnosis using fine-needle aspiration.60 Thus, the technology now exists
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2022, Academic RadiologyCitation Excerpt :In the absence of visualization on MRI, a strong suspicion for PDAC still persists in the presence of secondary signs (described in the subsequent section) and an EUS should be recommended. Resection of small PDACs are associated with higher rates of negative resection margins and better survival rates, reiterating the need for early diagnosis of these tumors (14). Abnormalities involving the pancreatic duct that may suggest PDAC include “duct-interrupted”, “corona” and “double duct” signs (12).
Early prediction of pancreatic cancer from new-onset diabetes: an Associazione Italiana Oncologia Medica (AIOM)/Associazione Medici Diabetologi (AMD)/Società Italiana Endocrinologia (SIE)/Società Italiana Farmacologia (SIF) multidisciplinary consensus position paper
2021, ESMO OpenCitation Excerpt :As previously mentioned, CA 19-9, the most widely employed marker, is insufficiently sensitive and unable to detect PC in asymptomatic patients.62 Additional risk factors potentially ‘enriching’ the NOD patient population are advanced age,59 sudden weight loss and/or low BMI at the time of the DM diagnosis,63 fast worsening of glucose control, or rapid development of hyperglycemia.64,65 As already mentioned, a promising risk stratification model has been identified and is awaiting validation (END-PAC),10 along with some other predictive models for clinical risk prediction.9,50
Liquid biopsy techniques and pancreatic cancer: diagnosis, monitoring, and evaluation
2023, Molecular Cancer
Supported by grants from the National Institutes of Health (R01 CA 100685) and the Lustgarten Foundation.