Pancreatic adenocarcinoma: A review of recent paradigms and advances in epidemiology, clinical diagnosis and management

Abstract

Pancreatic cancer is one of the dreaded malignancies for both the patient and the clinician. The five-year survival rate of pancreatic adenocarcinoma (PDA) is as low as 2% despite multimodality treatment even in the best hands. As per the Global Cancer Observatory of the International Agency for Research in Cancer estimates of pancreatic cancer, by 2040, a 61.7% increase is expected in the total number of cases globally. With the widespread availability of next-generation sequencing, the entire genome of the tumors is being sequenced regularly, providing insight into their pathogenesis. As invasive PDA arises from pancreatic intraepithelial neoplasia and mucinous neoplasm and intraductal papillary neoplasm, screening for them can be beneficial as the disease is curable with resection at an early stage. Routine preoperative biliary drainage has no role in patients suffering from PDA with obstructive jaundice. If performed, metallic stents are preferred over plastic ones. Minimally invasive procedures are preferred to open procedures as they have less morbidity. The duct-to-mucosa technique for pancreaticojejunostomy is presently widely practiced. The role of intraperitoneal drains after surgery for PDA is controversial. Neoadjuvant chemoradiotherapy has been proven to have a significant role both in locally advanced as well as in resectable PDA. Many new regimens and drugs have been added in the arsenal of chemoradiotherapy for metastatic disease. The roles of immunotherapy and gene therapy in PDA are being investigated. This review article is intended to improve the understanding of the readers with respect to the latest updates of PDA, which may help to trigger new research ideas and make better management decisions.

Sequestration of Intestinal Acidic Toxins by Cationic Resin Attenuates Pancreatic Cancer Progression through Promoting Autophagic Flux for YAP Degradation

“…Moreover, clinical trials using lysosome inhibitors, such as hydroxychloroquine, failed to improve the survival rate of pancreatic cancer [78,79]. Mechanistically, transition from PanIN to PDAC was accompanied by genetic alteration including KRAS, TP53, and CDKN2A [80]. Of note, a recent study pointed out that autophagic flux serves as a gate-keeper for genome instability, limiting genetic mutation accumulation and implying that autophagic flux can suppress pancreatic cancer progression [81].…”

The Role of Endoscopic Ultrasonography in the Diagnosis and Staging of Pancreatic Cancer

“…The goal of neoadjuvant therapy in PDAC is to improve patients' overall survival by improving tumor resectability with negative margins [180,181]. Neoadjuvant chemotherapy and/or chemoradiation are established in the current guidelines for borderline resectable disease [181,182]. The role of radiation therapy is continuously evolving.…”

Cancer of the Pancreas: An Integrative Review on Treatment

“…Preoperative preparation is critical to optimizing patient care 7 . Such assessment includes analyzing the relationship of the tumor to the vessels adjacent to it, such as the portal vein (PV), superior mesenteric vein (SMV), superior mesenteric artery (SMA), celiac axis (CA), hepatic artery (HA), along with the presence of metastases (most commonly liver, peritoneum, lungs).…”