Review article: current practice and future perspectives in detection and diagnosis of pancreatic cancer

Abstract

Pancreatic cancer is the tenth most prevalent malignancy and the fifth most common cause of cancer death in the developed world. Less than 10% of patients survive for more than 1 year following diagnosis and the 5-year survival rate (0.4%) is the lowest of any cancer. The poor prognosis associated with this diagnosis led in the past to therapeutic nihilism on the part of clinicians who were all too aware of the limitations of their available therapeutic strategies. Breaking this therapeutic impasse requires a significant expansion in the knowledge of clinicians concerning the pathogenesis and behaviour of pancreatic cancer. Recent advances in the scientific understanding of the aetiology of pancreatic cancer has facilitated progress towards the development of promising and innovative approaches to the early detection and diagnosis of pancreatic cancer. While acknowledging that pancreatic cancer will continue to present significant challenges to both scientists and clinicians in the foreseeable future, it is becoming increasingly clear that recent advances in our scientific knowledge base holds the potential to significantly improve prognosis for patients. The challenge facing both scientists and clinicians is how best to translate such promising scientific advances into survival and quality of life benefits to patients.

Molecular imaging in pancreatic cancer – A roadmap for therapeutic decisions

“…In contrast to other imaging modalities, it offers significant advantages such as real-time imaging acquisition, wide availability, safety and low cost. This technique, however, is limited by operator dependence, resulting in variable accuracy ranging from 57% to 81% [36]. Introduction of Doppler-based methods for assessing the direction and velocity of blood flow have expanded the diagnostic capabilities of US, but Doppler cannot be used to assess microvascular blood flow of tissues.…”

Adjuvante und additive Therapie beim Pankreaskarzinom

“…Die 5-Jahres-Überlebensrate beträgt hingegen nur 0,4-3% [10]. Die Gründe für die schlechte Prognose liegen vor allem in der späten Diagnosestellung [29],einer aggressiven Tumorzellbiologie mit weitgehender Therapieresistenz [47] und der Tatsache,dass bei akzeptabler Resektionsrate eine geringe postoperative Mortalität nur in spezialisierten Zentren erreicht werden kann [9,55].…”

Cost-Effectiveness Decision Analyses Comparing Covered to Uncovered Self-Expandable Metal Stents to Elective or on Demand Polyethylene Stent Changes in Patients with Distal Malignant Biliary Obstruction

“…[12,[66][67][68]. In the majority of cases, the combination of these modalities is sufficient to make an accurate diagnosis and staging.…”

“…Although not always present, obstruction of the distal common bile duct (CBD) occurs during the natural evolution of most of these tumors Odepending on their location and behavior [12]. The most common malignancy causing distal biliary malignant obstruction is pancreatic cancer followed by gallbladder cancer, malignant lymphadenopathy and cholangiocarcinoma, the latter being relatively uncommon in western countries [49,61,62].…”

“…In the majority of cases, patients are deemed not curable at the time of diagnosis or are not suitable to undergo a surgical curative procedure, and palliative treatment of the biliary obstruction is indicated. While re-establishment of the normal bile flow has no impact on survival [12], it has been shown to prevent complications related to the long-term obstruction and to improve quality oflife in sorne patients [13][14][15].…”