Current Treatment Options in Gastroenterology

, Volume 6, Issue 5, pp 349–358 | Cite as

Management of patients at high risk for pancreatic cancer

  • Supot Pongprasobchai
  • Suresh T. Chari

Opinion statement

Because pancreatic cancer patients seldom exhibit disease-specific symptoms until the cancer is at an advanced stage, its diagnosis is a virtual death sentence. Therefore, to make a significant impact on long-term survival for subjects with pancreatic cancer, asymptomatic individuals would have to be screened for premalignant precursors of pancreatic cancer or for asymptomatic pancreatic cancer. A number of formidable obstacles limit the ability of healthcare providers to screen for early neoplastic changes and to make a very early and specific diagnosis of pancreatic cancer. These include lack of a high-risk population for sporadic pancreatic cancer and lack of a simple, noninvasive test sensitive enough to detect small cancers. However, progress is being made in defining various high-risk groups for pancreatic cancer, and improvements in imaging modalities make detection of premalignant lesions and small cancers possible in such individuals. The protocols currently being studied, including use of endoscopic ultrasound and endoscopic retrograde cholangiopancreatography to detect precancerous lesions and small pancreatic cancer in high-risk patients, are still in the research arena and not yet ready for clinical practice.


Pancreatitis Pancreatic Cancer Chronic Pancreatitis Lynch Syndrome Pancreatic Juice 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Poston GJ, Williamson RC: Causes, diagnosis, and management of exocrine pancreatic cancer. Compr Ther 1990, 16:36–42.PubMedGoogle Scholar
  2. 2.
    Hruban RH, Adsay NV, Albores-Saavedra J, et al.: Pancreatic intraepithelial neoplasia: a new nomenclature and classification system for pancreatic duct lesions. Am J Surg Pathol 2001, 25:579–586. An excellent description of preneoplastic lesions of pancreatic cancerPubMedCrossRefGoogle Scholar
  3. 3.
    Brat DJ, Lillemoe KD, Yeo CJ, et al.: Progression of pancreatic intraductal neoplasias to infiltrating adenocarcinoma of the pancreas. Am J Surg Pathol 1998, 22:163–169.PubMedCrossRefGoogle Scholar
  4. 4.
    Ariyama J, Suyama M, Satoh K, et al.: Imaging of small pancreatic ductal adenocarcinoma. Pancreas 1998, 16:396–401.PubMedCrossRefGoogle Scholar
  5. 5.
    Tsuchiya R, Noda T, Harada N, et al.: Collective review of small carcinomas of the pancreas. Ann Surg 1986, 203:77–81.PubMedCrossRefGoogle Scholar
  6. 6.
    Brentnall TA, Bronner MP, Byrd DR, et al.: Early diagnosis and treatment of pancreatic dysplasia in patients with a family history of pancreatic cancer. Ann Intern Med 1999, 131:247–255.PubMedGoogle Scholar
  7. 7.
    Goggins M, Canto MI, Hruban R: Can we screen highrisk individuals to detect early pancreatic carcinoma? J Surg Oncol 2000, 74:243–248.PubMedCrossRefGoogle Scholar
  8. 8.
    Canto M, Wroblewski L, Goggins M, et al.: Screening for pancreatic neoplasia in high-risk individuals: The Johns Hopkins Experience. Gastroenterology 2002, 122(suppl 1):A-17.Google Scholar
  9. 9.
    Eberle MA, Pfutzer R, Pogue-Geile KL, et al.: A new susceptibility locus for autosomal dominant pancreatic cancer maps to chromosome 4q32-34. Am J Hum Genet 2002, 70:1044–1048. Report of a new susceptibility locus for autosomal dominant form of pancreatic cancerPubMedCrossRefGoogle Scholar
  10. 10.
    Lynch HT, Smyrk T, Kern SE, et al.: Familial pancreatic cancer: a review. Semin Oncol 1996, 23:251–275.PubMedGoogle Scholar
  11. 11.
    Efthimiou E, Crnogorac-Jurcevic T, Lemoine NR, et al.: Inherited predisposition to pancreatic cancer. Gut 2001, 48:143–147.PubMedCrossRefGoogle Scholar
  12. 12.
    Wong T, Howes N, Threadgold J, et al.: Molecular diagnosis of early pancreatic ductal adenocarcinoma in high-risk patients. Pancreatology 2001, 1:486–509. Discusses role of molecular markers in screening for pancreatic cancerPubMedCrossRefGoogle Scholar
  13. 13.
    Lynch HT, Brand RE, Lynch JF, et al.: Hereditary factors in pancreatic cancer. J Hepatobiliary Pancreat Surg 2002, 9:12–31. Review of current state of knowledge of hereditary and environmental factors in pancreatic carcinogenesis.PubMedCrossRefGoogle Scholar
  14. 14.
    Lowenfels AB, Maisonneuve P, DiMagno EP, et al.: Hereditary pancreatitis and the risk of pancreatic cancer. International Hereditary Pancreatitis Study Group. J Natl Cancer Inst 1997, 89:442–446.PubMedCrossRefGoogle Scholar
  15. 15.
    Lowenfels AB, Maisonneuve P, Whitcomb DC: Risk factors for cancer in hereditary pancreatitis. International Hereditary Pancreatitis Study Group. Med Clin North Am 2000, 84:565–573.PubMedCrossRefGoogle Scholar
  16. 16.
    Lowenfels AB, Maisonneuve P, Whitcomb DC, et al.: Cigarette smoking as a risk factor for pancreatic cancer in patients with hereditary pancreatitis. JAMA 2001, 286:169–170. Important study.PubMedCrossRefGoogle Scholar
  17. 17.
    Howes N, Wong T, Greenhalf W, et al.: Pancreatic cancer risk in hereditary pancreatitis in Europe. Digestion 2000, 61:300.Google Scholar
  18. 18.
    Chari ST, Mohan V, Pitchumoni CS, et al.: Risk of pancreatic carcinoma in tropical calcifying pancreatitis: an epidemiologic study. Pancreas 1994, 9:62–66.PubMedCrossRefGoogle Scholar
  19. 19.
    Lowenfels AB, Maisonneuve P, Cavallini G, et al.: Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med 1993, 328:1433–1437.PubMedCrossRefGoogle Scholar
  20. 20.
    Talamini G, Falconi M, Bassi C, et al.: Incidence of cancer in the course of chronic pancreatitis. Am J Gastroenterol 1999, 94:1253–1260.PubMedCrossRefGoogle Scholar
  21. 21.
    Malka D, Hammel P, Maire F, et al.: Risk of pancreatic adenocarcinoma in chronic pancreatitis. Gut 2002, 51:849–852.PubMedCrossRefGoogle Scholar
  22. 22.
    Hahn SA, Greenhalf B, Ellis I, et al.: BRCA2 germline mutations in familial pancreatic carcinoma. J Natl Cancer Inst 2003, 95:214–221. Data from this study support an important role for BRCA2 germline mutations in a subpopulation of families with familial pancreatic cancer.PubMedCrossRefGoogle Scholar
  23. 23.
    Rulyak SJ, Brentnall TA: Inherited pancreatic cancer: surveillance and treatment strategies for affected families. Pancreatology 2001, 1:477–485. Discusses the University of Washington group’s cancer surveillance strategy.PubMedCrossRefGoogle Scholar
  24. 24.
    Ghadirian P, Liu G, Gallinger S, et al.: Risk of pancreatic cancer among individuals with a family history of cancer of the pancreas. Int J Cancer 2002, 97:807–810.PubMedCrossRefGoogle Scholar
  25. 25.
    Fernandez E, La Vecchia C, D’Avanzo B, et al.: Family history and the risk of liver, gallbladder, and pancreatic cancer. Cancer Epidemiol Biomarkers Prev 1994, 3:209–212.PubMedGoogle Scholar
  26. 26.
    Silverman DT, Schiffman M, Everhart J, et al.: Diabetes mellitus, other medical conditions and familial history of cancer as risk factors for pancreatic cancer. Br J Cancer 1999, 80:1830–1837.PubMedCrossRefGoogle Scholar
  27. 27.
    Hruban RH, Canto MI, Yeo CJ: Prevention of pancreatic cancer and strategies for management of familial pancreatic cancer. Dig Dis 2001, 19:76–84.PubMedCrossRefGoogle Scholar
  28. 28.
    Tersmette AC, Petersen GM, Offerhaus GJ, et al.: Increased risk of incident pancreatic cancer among first-degree relatives of patients with familial pancreatic cancer. Clin Cancer Res 2001, 7:738–744. The first analysis of incident PaC occurring in familial PaC kindreds showed that the risk and incidence of PaC is exceptionally high among at-risk first-degree relatives in familial PaC kindreds in which at least three first-degree relatives have already been diagnosed with PaC.PubMedGoogle Scholar
  29. 29.
    Fisher WE: Diabetes: risk factor for the development of pancreatic cancer or manifestation of the disease? World J Surg 2001, 25:503–508.PubMedCrossRefGoogle Scholar
  30. 30.
    Everhart J, Wright D: Diabetes mellitus as a risk factor for pancreatic cancer. A meta-analysis. JAMA 1995, 273:1605–1609.PubMedCrossRefGoogle Scholar
  31. 31.
    Noy A, Bilezikian JP: Clinical review 63: Diabetes and pancreatic cancer: clues to the early diagnosis of pancreatic malignancy. J Clin Endocrinol Metab 1994, 79:1223–1231.PubMedCrossRefGoogle Scholar
  32. 32.
    Gullo L, Pezzilli R, Morselli-Labate AM: Diabetes and the risk of pancreatic cancer. Italian Pancreatic Cancer Study Group. N Engl J Med 1994, 331:81–84.PubMedCrossRefGoogle Scholar
  33. 33.
    Cersosimo E, Pisters PW, Pesola G, et al.: Insulin secretion and action in patients with pancreatic cancer. Cancer 1991, 67:486–493.PubMedCrossRefGoogle Scholar
  34. 34.
    Permert J, Larsson J, Ihse I, et al.: Diagnosis of pancreatic cancer. Alteration of glucose metabolism. Int J Pancreatol 1991, 9:113–117.PubMedGoogle Scholar
  35. 35.
    Permert J, Ihse I, Jorfeldt L, et al.: Pancreatic cancer is associated with impaired glucose metabolism. Eur J Surg 1993, 159:101–107.PubMedGoogle Scholar
  36. 36.
    Chari ST, Klee GG, Miller LJ, et al.: Islet amyloid polypeptide is not a satisfactory marker for detecting pancreatic cancer. Gastroenterology 2001, 121:640–645.PubMedCrossRefGoogle Scholar
  37. 37.
    Permert J, Ihse I, Jorfeldt L, et al.: Improved glucose metabolism after subtotal pancreatectomy for pancreatic cancer. Br J Surg 1993, 80:1047–1050.PubMedCrossRefGoogle Scholar
  38. 38.
    Chari S, Leibson CL, Petersen, et al.: Probability of pancreatic cancer following diagnosis of diabetes: a population-based study. Gastroenterology 2002, 122(suppl 1):A-27.Google Scholar
  39. 39.
    Michaud DS, Giovannucci E, Willett WC, et al.: Physical activity, obesity, height, and the risk of pancreatic cancer. JAMA 2001, 286:921–929.PubMedCrossRefGoogle Scholar
  40. 40.
    Schenk M, Schwartz AG, O’Neal E, et al.: Familial risk of pancreatic cancer. J Natl Cancer Inst 2001, 93:640–644.PubMedCrossRefGoogle Scholar
  41. 41.
    Anderson KE, Johnson TW, Lazovich D, et al.: Association between nonsteroidal anti-inflammatory drug use and the incidence of pancreatic cancer. J Natl Cancer Inst 2002, 94:1168–1171.PubMedGoogle Scholar
  42. 42.
    Brentnall TA: Cancer surveillance of patients from familial pancreatic cancer kindreds. Med Clin North Am 2000, 84:707–718.PubMedCrossRefGoogle Scholar
  43. 43.
    Permert J, Larsson J, Westermark GT, et al.: Islet amyloid polypeptide in patients with pancreatic cancer and diabetes. N Engl J Med 1994, 330:313–318.PubMedCrossRefGoogle Scholar
  44. 44.
    Diederich S, Wormanns D, Semik M, et al.: Screening for early lung cancer with low-dose spiral CT: prevalence in 817 asymptomatic smokers. Radiology 2002, 222:773–781.PubMedCrossRefGoogle Scholar
  45. 45.
    Howes N, Greenhalf W, Neoptolemos J: Screening for early pancreatic ductal adenocarcinoma in hereditary pancreatitis. Med Clin North Am 2000, 84:719–738.PubMedCrossRefGoogle Scholar
  46. 46.
    Martin SP, Ulrich CD 2nd: Pancreatic cancer surveillance in a high-risk cohort. Is it worth the cost? Med Clin North Am 2000, 84:739–747.PubMedCrossRefGoogle Scholar
  47. 47.
    Muller MF, Meyenberger C, Bertschinger P, et al.: Pancreatic tumors: evaluation with endoscopic US, CT and MR imaging. Radiology 1994, 190:745–751.PubMedGoogle Scholar
  48. 48.
    Furukawa H, Okada S, Saisho H, et al.: Clinicopathologic features of small pancreatic adenocarcinoma. A collective study. Cancer 1996, 78:986–990.PubMedCrossRefGoogle Scholar
  49. 49.
    Furukawa H, Okada S, Kakizoe T: Early diagnosis of pancreatic cancer. Hepatogastroenterology 1999, 46:4–7.PubMedGoogle Scholar
  50. 50.
    Ishikawa O, Ohigashi H, Imaoka S, et al.: Minute carcinoma of the pancreas measuring 1 cm or less in diameter —collective review of Japanese case reports. Hepatogastroenterology 1999, 46:8–15.PubMedGoogle Scholar
  51. 51.
    Lohr M, Maisonneuve P, Lowenfels AB: K-ras mutations and benign pancreatic disease. Int J Pancreatol 2000, 27:93–103.PubMedGoogle Scholar
  52. 52.
    Steinberg WM, Barkin J, Bradley EL 3rd, et al.: Workup of a patient with familial pancreatic cancer. Pancreas 1999, 18:219–224.PubMedCrossRefGoogle Scholar
  53. 53.
    Ulrich CD: Pancreatic cancer in hereditary pancreatitis: consensus guidelines for prevention, screening and treatment. Pancreatology 2001, 1:416–422. Consensus guidelines for prevention, screening, and treatment of pancreatic cancer in hereditary pancreatitisPubMedCrossRefGoogle Scholar
  54. 54.
    Ogawa Y, Tanaka M, Inoue K, et al.: A prospective pancreatographic study of the prevalence of pancreatic carcinoma in patients with diabetes mellitus. Cancer 2002, 94:2344–2349.PubMedCrossRefGoogle Scholar
  55. 55.
    Bartsch DK, Sina-Frey M, Ziegler A, et al.: Update of familial pancreatic cancer in Germany. Pancreatology 2001, 1:510–516.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • Supot Pongprasobchai
    • 1
  • Suresh T. Chari
    • 1
  1. 1.Division of Gastroenterology and Hepatology, Department of Internal MedicineMayo ClinicRochesterUSA

Personalised recommendations