Gastroenterology

Gastroenterology

Volume 156, Issue 7, May 2019, Pages 2024-2040
Gastroenterology

Pancreatic Cancer
Early Detection of Pancreatic Cancer: Opportunities and Challenges

https://doi.org/10.1053/j.gastro.2019.01.259Get rights and content
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open access

Most patients with pancreatic ductal adenocarcinoma (PDAC) present with symptomatic, surgically unresectable disease. Although the goal of early detection of PDAC is laudable and likely to result in significant improvement in overall survival, the relatively low prevalence of PDAC renders general population screening infeasible. The challenges of early detection include identification of at-risk individuals in the general population who would benefit from longitudinal surveillance programs and appropriate biomarker and imaging-based modalities used for PDAC surveillance in such cohorts. In recent years, various subgroups at higher-than-average risk for PDAC have been identified, including those with familial risk due to germline mutations, a history of pancreatitis, patients with mucinous pancreatic cysts, and elderly patients with new-onset diabetes. The last 2 categories are discussed at length in terms of the opportunities and challenges they present for PDAC early detection. We also discuss current and emerging imaging modalities that are critical to identifying early, potentially curable PDAC in high-risk cohorts on surveillance.

Keywords

Biomarker
Risk Stratification
Pre-diagnostic

Abbreviations used in this paper

ACG
American College of Gastroenterology
ACR
American College of Radiology
AGA
American Gastroenterological Association
BD-IPMN
branched-duct intraductal papillary mucinous neoplasms
BMI
body mass index
CEA
carcinoembryonic antigen
CT
computed tomography
DM
diabetes mellitus
ESGCTP
European Study Group on Cystic Tumors of the Pancreas
EUS
endoscopic ultrasound
FBG
fasting blood glucose
IPMN
intraductal papillary mucinous neoplasms
MCN
mucinous cystic neoplasm
MD-IPMN
main-duct intraductal papillary mucinous neoplasms
MPD
main pancreatic duct
MRCP
magnetic resonance cholangiopancreatography
MRI
magnetic resonance imaging
MT-IPMN
main-type intraductal papillary mucinous neoplasms
MUC
mucin
NGS
next-generation sequencing
NOD
new-onset diabetes
PCF
pancreatic cyst fluid
PDAC
pancreatic ductal adenocarcinoma

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Conflicts of interest These authors disclose the following: Aatur D. Singhi, Foundation Medicine (honorarium). Eugene J. Koay, Philips Healthcare (sponsored research agreement), GE Healthcare (in-kind grant). The remaining authors disclose no conflicts.

Funding This work was supported by National Cancer Institute (NCI) U01 CA196403 (Anirban Maitra and Eugene J. Koay), NCI U01 CA200468 (Anirban Maitra and Eugene J. Koay), NCI R01 CA218004 (Anirban Maitra and Eugene J. Koay), the Consortium for Study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer (National Institutes of Health DK108288) (Suresh T. Chari), Kenner Family Research Fund (Suresh T. Chari), Prokopanko Gift to Mayo Foundation (Suresh T. Chari), Pancreatic Cancer Action Network (Anirban Maitra, Eugene J. Koay, and Aatur D. Singhi), The Sky Foundation (Aatur D. Singhi), and a Stand Up To Cancer–Lustgarten Foundation Pancreatic Cancer Interception Translational Cancer Research Grant (grant number: SU2C-AACR-DT25-17) (Anirban Maitra and Eugene J. Koay). Stand Up To Cancer is a program of the Entertainment Industry Foundation. Research grants are administered by the American Association for Cancer Research, the scientific partner of SU2C. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or any other funding source.