Screening for Pancreatic Cancer

Abstract

Pancreatic cancer is the fourth most common cause of cancer mortality in the United States, with 5 year survival rates for patients with resectable tumors ranging from 15 - 20%. However, most patients present with distant metastases, are not resectable, and have a 5-year survival of close to 0%. This demonstrates a need for improved screening to identify pancreatic cancer while the tumor is localized and amenable to surgical resection. Studies of patients with pancreatic tumors incidentally diagnosed demonstrate longer median survival as compared with tumors discovered only when the patient is symptomatic, suggesting that early detection may improve outcome. Recent evidence from genomic sequencing indicates a 15 year interval for genetic progression of pancreatic cancer from initiation to the metastatic stage, suggesting a sufficient window for early detection. Still, many challenges remain in implementing effective screening. Early diagnosis of pancreatic cancer relies on developing screening methodologies with highly sensitive and specific biomarkers and imaging modalities. It also depends on a better understanding of the risk factors and natural history of the disease in order to accurately identify high risk groups that would be best served by screening. This review summarizes our current understanding of the biology of pancreatic cancer relevant to methods available for screening. At this time, given the lack of proven benefit in this disease, screening efforts should probably be undertaken in the context of prospective trials.

Non‐alcoholic fatty pancreas disease as a risk factor for pancreatic cancer based on endoscopic ultrasound examination among pancreatic cancer patients: A single‐center experience

“…Most of them usually present with jaundice due to bile duct obstruction, and this symptom is a sign of advance disease. Another major drawback is that early screening is also difficult due to its anatomical location 9. The most routine biomarker used, CA 19‐9, is considered not to be clinically effective because of the wide range of sensitivity and specificity (68–90%).…”

“…However, the radiation risk and contrast agent exposure during CT examination makes this modality not suitable for routine screening and surveillance. The long durability of MRI examination time and the cost also become debatable matters when using this modality for early detection and screening in general population 9, 10, 11…”

Distribution of Cholecystokinin-B Receptor Genotype Between Patients With Pancreatic Cancer and Controls and Its Impact on Survival

“…Reasons for the poor survival rates reported for pancreatic cancer include both the inability to diagnose this disease in the early stages and also the aggressive nature of this malignancy. 7 Although surgical resection offers a potential chance for a cure for pancreatic cancer if detected early, 8 over 90% of the subjects have advanced disease at the time of presentation. 9 Unfortunately, even in the absence of macroscopic disease during surgery and with combined administration of adjuvant chemotherapy, only 20.7% of surgically resected patients survive 5 years.…”

The Lncrna-TUG1/EZH2 Axis Promotes Pancreatic Cancer Cell Proliferation, Migration and EMT Phenotype Formation Through Sponging Mir-382

“…Due to a lack of efficient methods for early diagnosis, patients are always diagnosed at an advanced stage. Currently, surgical resection is an important treatment for PC; however, only 10-20% of patients are diagnosed at a resectable stage and the 5-year survival of post-operation for PC is still unsatisfactory at only 20% [3]. Thus, chemotherapy becomes one of the indispensable means of clinical treatment for PC.…”