American Gastroenterological AssociationAGA technical review on the epidemiology, diagnosis, and treatment of pancreatic ductal adenocarcinoma☆
Section snippets
Literature review methods
We included only studies published after 1980. A literature search was initiated using MEDLINE and the medical subject terms pancreatic cancer with the cross-references epidemiology, diagnosis, chemotherapy, radiotherapy, and surgery. Secondary searches were also performed for each major category.
For epidemiology, secondary searches were undertaken using pancreatic cancer. To ascertain the national incidence of pancreatic cancer in the United States, we used cancer statistics from the National
Populations at risk for developing pancreatic cancer
Early diagnosis of cancer has been thwarted because populations at risk for developing pancreatic cancer have not been identified until recently. Although there is some debate about the risk of pancreatic cancer in patients with chronic pancreatitis, the strongest evidence for this association is in hereditary pancreatitis. In this disease, the estimated cumulative risk of pancreatic cancer to age 70 is 40%, but the estimated cumulative risk for developing pancreatic cancer in patients with a
Symptoms and signs
The suspicion of pancreatic cancer arises because of symptoms of pain, jaundice, anorexia, early satiety, or weight loss. Some symptoms may predict tumor location37 and prognosis.38 Painless jaundice is the most common presentation in patients with a potentially resectable and curable lesion (52% of patients with a resectable lesion). However, pain is the most frequent symptom (80% of all patients) and is present in 80% and 85% of patients with locally unresectable and advanced cancer,
Preoperative management
All patients undergoing pancreatic surgery require preoperative optimization of cardiac, pulmonary, and renal function, which is usually done in the outpatient setting. Although patients often have lost weight, the nutritional status of most is satisfactory enough for them to undergo surgery safely. However, if the serum albumin concentration is <3 g/dL or surgery is delayed for more than several weeks, supplemental enteral nutrition is indicated. Pancreatic enzyme replacement also should be
Epidemiology
Pancreatic cancer is deadly; overall 5-year survival is <5%. However, 5-year survival rates of >20% may accompany resection of “early tumors,” defined as tumors that measure ≤2 cm and are confined to the pancreas. Identification of patients with early cancer in populations at risk for developing pancreatic cancer should increase 5-year survival. At present, patients with idiopathic and alcoholic chronic pancreatitis and new-onset diabetes mellitus (<2 years, no family history, age >50 years)
Future research
Improving survival of pancreatic cancer patients depends on identification of patients who are at risk for developing pancreatic cancer, detection of disease at an early curable stage, and elucidation of the basic mechanisms of differentiation and transformation involved in pancreatic carcinogenesis that will lead to development of effective treatment to prevent or counteract these abnormalities. The best lead for early identification of pancreatic cancer is exploration of genetic and other
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Lymphatic vessel remodeling and invasion in pancreatic cancer progression
2019, EBioMedicineCitation Excerpt :When diseases such as pancreatitis or neoplasm occur, the lymphatic system plays an essential role in host defenses in response to inflammation and malignant transformation. Clinically, the association of lymphatics with pancreatic duct lesion progression is demonstrated by the lymph node metastasis in pancreatic ductal adenocarcinoma (PDAC) [3–7]. In particular, lymphatic spread has been used as a key prognostic factor to assess the invasiveness of tumor cells [4–6].
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