The Early Detection of Pancreatic Cancer: What Will It Take to Diagnose and Treat Curable Pancreatic Neoplasia?

Abstract

Pancreatic cancer is the deadliest of all solid malignancies. Early detection offers the best hope for a cure, but characteristics of this disease such as the lack of early clinical symptoms, make the early detection difficult. Recent genetic mapping of the molecular evolution of pancreatic cancer suggests that a large window of opportunity exists for the early detection of pancreatic neoplasia, and developments in cancer genetics offer new, potentially highly specific, approaches for screening for curable pancreatic neoplasia. We review the challenges of screening for early pancreatic neoplasia, as well as opportunities presented by incorporating molecular genetics into these efforts.

Etiologic Link Between Chronic Pancreatitis and Pancreatic Cancer; A Unicentric Experience of Pancreatic Disease Institute of Wuhan Union Hospital of China

“…(4) The body and tail of pancreas as a location has been showed by many publications [1,13]. (5) The incidence of both diseases increased simultaneously in many countries [29,32]. (6) Man was more affected in both groups than female with a sex ratio of nearly 2:1(p=0.001,table 1).Clinical symptoms were of no great value since they hardly differ in PC and CP.…”

The genetic classification of pancreatic neoplasia

“…These include microscopic precursor lesions called pancreatic intraepithelial neoplasia (PanIN) lesions, and larger cystic precursor lesions called intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) [21,22]. These precursor lesions are important because they represent an opportunity to detect and treat pancreatic neoplasia before it progresses to an incurable invasive carcinoma [23].…”

“…This suggests a reasonably large window for the early detection of curable pancreatic neoplasia [56]. Pancreatic cancer is, however, a relatively rare disease, and screening efforts will have to be focused on populations with an elevated risk of developing the disease [23]. Again, our genetic understanding can help here as well, as individuals with a strong family history of PDA and individuals who carry a known genetic predisposition, because of their quantifiably increased risk, would be the first to benefit from early detection efforts [57,58].…”

Hereditary Pancreatic Cancer

“…Pancreatic cancer has been shown through several studies to have a hereditary disposition with estimates ranging from 3 to 16% of newly diagnosed cases [3,4]. There are several germline mutations that have shown to be at risk for the development of pancreatic cancer, including BRCA1, BRCA2, ATM, PALB2, CDKN2A, STK11, PRSS1, MEN1, MSH2, VHL, TP53, PALLD, EPCAM, MLH1, MSH6, APC, and FANCC [5,6].…”