Pancreatic Cancer Screening
Section snippets
Pancreatic Cancer: Why Consider Screening?
Pancreatic cancer remains one of the most deadly diseases, despite significant advances in medicine over the past decade. Pancreatic adenocarcinoma is the fourth leading cause of cancer deaths in the United States for both males and females, with an estimated 44,030 new cases and 37,660 deaths in 2011.1 In contrast to the death rates for other leading causes of cancer death (lung, colorectal, breast, and prostate), which have declined since 2003, the death rate from pancreatic adenocarcinoma
Genetic Predisposition to Pancreatic Cancer
Although the great majority of pancreatic adenocarcinoma cases are thought to be sporadic in nature, up to 10% of cases can be attributed to genetic factors.2, 3, 4 In fact, familial clustering of pancreatic cancer was noted as early as 1967, when Lynch and colleagues reported on an adenocarcinoma-prone family.5 Familial pancreatic cancer (FPC) is characterized by two or more first-degree relatives (FDRs) with pancreatic adenocarcinoma in the absence of known cancer syndromes or other diseases
Hereditary Pancreatitis
Hereditary pancreatitis is a rare inherited disorder characterized by recurrent attacks of acute pancreatitis in childhood or early adolescence, followed by the development of chronic pancreatitis in late adolescence or early adulthood.26 It is transmitted as an autosomal dominant disorder with incomplete penetrance.27 Most are due to germline gain-of-function mutations in a cationic trypsinogen gene (PRSS1) on chromosome 7q35.28, 29, 30 Mutations in PRSS1 cause premature trypsin activation and
Targets for Screening and Surveillance
The ideal screening strategy for pancreatic cancer would target high-grade benign noninvasive precursor neoplastic lesions (pancreatic intraepithelial neoplasias [PanINs] or intraductal papillary mucinous neoplasms [IPMNs]) before malignant transformation or at an early stage that would allow for curative surgical resection.56 Although IPMNs can be detected as cystic lesions or a dilated main pancreatic duct or both, PanINs are small branch ducts less than 5 mm in size, often microscopic, and
Available and Anticipated Tumor Markers
Currently, there is no biomarker with adequate sensitivity and specificity that can be used for routine clinical screening.57 Given the typical late stage of disease at the time of diagnosis, there has been much effort invested in identifying accurate tumor markers to aid in earlier diagnosis of pancreatic cancer.
The most widely used serum marker in patients with pancreatic cancer is sialylated Lewis blood group antigen on MUC-1 (Mucin 1, cell surface associated), carbohydrate antigen 19-9 (CA
Approaches to Screening
Currently, there is no sufficiently sensitive, specific, and reliable screening test for the early detection of pancreatic cancer. The great majority of pancreatic cancers, accounting for at least 90% of all patients, are considered sporadic.2, 3, 4 The detection rate is low in average-risk individuals because pancreatic cancer is a rare disease, despite its significant death toll. In screening studies performed in Japan, 5 cancers were found in 2511 individuals.114 Given the overall low
Summary
Accumulating data indicate that clinically available abdominal imaging tests such as EUS and MRI/MRCP can detect asymptomatic precursor benign (IPMN, PanIN) and invasive malignant pancreatic neoplasms, such as ductal adenocarcinoma, in individuals with an inherited predisposition. These asymptomatic FPCs detected have been more likely to be resectable, compared to symptomatic tumors. The most challenging part of screening high-risk individuals is the selection of individuals with high-grade
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Gemcitabine and rapamycin-loaded mixed polymeric thermogel for metastatic pancreatic cancer therapy
2023, Journal of Controlled ReleasePhotodynamic therapy for pancreatic cancer
2023, Recent Advances in Nanocarriers for Pancreatic Cancer TherapyNanomedicine for overcoming therapeutic and diagnostic challenges associated with pancreatic cancer
2022, Drug Discovery TodayCitation Excerpt :In one study, patients who were incidentally diagnosed had a median survival of 30 months compared with a median survival of 12 months for patients whose carcinoma was discovered through symptoms.8 Furthermore, symptoms of early-stage pancreatic cancer are not specific (nausea, vomiting, and weight loss) and can easily be confused with symptoms of other diseases, such as pancreatitis, because the more defining symptoms of pancreatic cancer (such as jaundice) typically emerge during more advanced stages of the disease.6 This delays the diagnosis and limits potential treatment options.9
Ethnic and racial disparities of pancreatic adenocarcinoma in Florida
2020, HPBCitation Excerpt :An estimated 55,440 new cases will occur in the United States in 2018, which is increased from 48,960 in 2015.1 Pancreatic cancer accounts for 2% of all cancers, and for 5% of cancer-related deaths.2 Racial disparities in survival have been documented for virtually all types of cancer.3,4
Radiomics in stratification of pancreatic cystic lesions: Machine learning in action
2020, Cancer LettersCitation Excerpt :More recently, this progression model was challenged by Notta et al. who proposed that pancreatic cancer progression is neither gradual nor follows a sequential mutational order to develop invasive cancer [10]. Regardless, there is a significant window of opportunity to intervene and reduce mortality if precursor neoplastic cystic lesions can be appropriately detected at a benign stage [11]. PCLs are divided into two categories: non-neoplastic and neoplastic cysts.
Pancreatic cancer screening in high-risk individuals with germline genetic mutations
2018, Gastrointestinal Endoscopy
The authors have nothing to disclose.