Advertisement

Clinical and Translational Oncology

, Volume 19, Issue 10, pp 1205–1216 | Cite as

Diagnosis and staging of pancreatic ductal adenocarcinoma

  • C. Guillén-PonceEmail author
  • J. Blázquez
  • I. González
  • E. de-Madaria
  • J. Montáns
  • A. Carrato
Review Article

Abstract

The management of pancreatic ductal adenocarcinoma (PDAC) is a major public health concern worldwide. Currently, most PDAC patients are diagnosed in advanced stages. The signs and symptoms of the disease, except for jaundice, are non-specific. Thus, the current challenge is to identify earlier those individuals for whom specific screening tools and specific treatments would be beneficial. On the basis of the recommendations of the group of experts of multiple medical specialties of the GALLgo Project, the patients with PDAC should be managed by a multidisciplinary team to assess the personal and family history, the best diagnostic and staging procedures and consider all important aspects for treatment decisions. In this article, the group of experts proposes strategies to shorten the diagnosis times in PDAC patients.

Keywords

Diagnosis Staging Pancreatic ductal adenocarcinoma 

Notes

Acknowledgements

The authors thank Sofía Perea, PharmD, PhD, for her support in writing the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

Medical writing was supported by Fundación ECO.

Informed consent

Not applicable.

Research involving human participants and/or animals

Not applicable.

References

  1. 1.
    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.CrossRefPubMedGoogle Scholar
  2. 2.
    Rahib L, Smith BD, Alzenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver and pancreas cancer in the United States. Cancer Res. 2014;74:2913–21.CrossRefPubMedGoogle Scholar
  3. 3.
    Hidalgo M, Cascinu S, Kleeff J, Labianca R, Löhr JM, Neoptolemos J, et al. Addressing the challenges of pancreatic cancer: future directions for improving outcomes. Pancreatology. 2015;15:8–18.CrossRefPubMedGoogle Scholar
  4. 4.
    Dykewicz CA. Summary of the guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Clin Infect Dis. 2001;33:139–44.CrossRefPubMedGoogle Scholar
  5. 5.
    Ducreux M, Cuhna AS, Caramella C, Hollebecque A, Burtin P, Goere D, et al. Cancer of the pancreas: ESMO clinical practice guidelines for diagnosis, treatment and follow-updagger. Ann Oncol. 2015;26:56–68.CrossRefGoogle Scholar
  6. 6.
    Hart PA, Kamada P, Rabe KG, Srinivasan S, Basu A, Aggarwal G, et al. Weight loss precedes cancer-specific symptoms in pancreatic cancer-associated diabetes mellitus. Pancreas. 2011;40:768–72.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Chari ST, Leibson CL, Rabe KG, Ransom J, de Andrade M, Petersen GM. Probability of pancreatic cancer following diabetes: a population-based study. Gastroenterology. 2005;129:504–11.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Ben Q, Xu M, Ning X, Liu J, Hong S, Huang W, et al. Diabetes mellitus and risk of pancreatic cancer: a meta-analysis of cohort studies. Eur J Cancer. 2011;47:1928–37.CrossRefPubMedGoogle Scholar
  9. 9.
    Canto MI, Harink F, Hruban RH, Offerhaus GJ, Poley JW, Kamen I, et al. International cancer of the pancreas screening consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut. 2013;62:339–47.CrossRefPubMedGoogle Scholar
  10. 10.
    Mocci E, Guillen-Ponce C, Earl J, Marquez M, Solera J, Salazar-López MT, et al. PanGen-Fam: Spanish registry of hereditary pancreatic cancer. Eur J Cancer. 2015;51:1911–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Canto MI, Goggins M, Hruban RH, Petersen GM, Giardello GM, Yeo C, et al. Screening for early pancreatic neoplasia in high-risk individuals: a prospective controlled study. Clin Gastroenterol Hepatol. 2006;4:766–81.CrossRefPubMedGoogle Scholar
  12. 12.
    Canto MI, Hruban RH, Fishman EK, Kamel IR, Schulick R, Zhang Z, et al. Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. Gastroenterology. 2012;142:796–804.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Humphris JL, Johns A, Simpson H, Cowley MJ, Pajic M, Chang DK, et al. Clinical and pathologic features of familial pancreatic cancer. Cancer. 2014;120:3669–75.CrossRefPubMedGoogle Scholar
  14. 14.
    Al-Hawary MM, Francis IR, Chari ST, Fishman EK, Hough DM, Lu DS, et al. Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology. 2014;270:248–60.CrossRefPubMedGoogle Scholar
  15. 15.
    Nawaz H, Fan CY, Kloke J, Khalid A, McGrath K, Landsittel D, et al. Performance characteristics of endoscopic ultrasound in the staging of pancreatic cancer: a meta-analysis. JOP. 2013;14:484–97.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Asbun HJ, Conlon K, Fernández-Cruz L, Friess H, Shrikhande SV, Adham L, et al. When to perform a pancreatoduodenectomy in the absence of positive histology? A consensus statement by the International Study Group of Pancreatic Surgery. Surgery. 2014;155:887–92.CrossRefPubMedGoogle Scholar
  17. 17.
    Munroe CA, Fehmi SM, Savides TJ. Endoscopic ultrasound in the diagnosis of pancreatic cancer. Expert Opin Med Diagn. 2013;7:25–35.CrossRefPubMedGoogle Scholar
  18. 18.
    Tanaka M, Chari S, Adsay W, Fernández-del Castillo C, Falconi M, Shimiz M, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;3:183–97.CrossRefGoogle Scholar
  19. 19.
    Cwik G, Wallner G, Skoczylas T, Ciechanski A, Zinkiewicz K, et al. Cancer antigens 19-9 and 125 in the differential diagnosis of pancreatic mass lesions. Arch Surg. 2006;141:968–73.CrossRefPubMedGoogle Scholar
  20. 20.
    Kondo N, Murakami Y, Uemura K, Hayashidani Y, Sudo T, Hashimoto Y, et al. Prognostic impact of perioperatory CA19.9 levels in patients with resectable pancreatic cáncer. Ann Surg Oncol. 2010;17:2321–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Humphris JL, Chang DK, Johns AL, Scarlett CJ, Pajic M, Jones MD, et al. The prognostic and predictive value of serum CA 19.9 in pancreatic cancer. Ann Oncol. 2012;23:1713–22.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Yu J, Blackford AL, Molin M, Wolfgang CL, Goggins M. Time to progression of pancreatic ductal adenocarcinoma from low-to-high tumour stages. Gut. 2015;64:1783–9.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Tamm EP, Balachandran A, Bhosale PR, Katz MH, Fleming JB, Lee JH, et al. Imaging of pancreatic adenocarcinoma: update on staging/resectability. Radiol Clin N Am. 2012;50:407–28.CrossRefPubMedGoogle Scholar
  24. 24.
    Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, et al. Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2014;155:977–88.CrossRefPubMedGoogle Scholar
  25. 25.
    Katz MH, Marsh R, Herman JM, Shi Q, Collison E, Venook AP, et al. Borderline resectable pancreatic cancer: need for standardization and methods for optimal clinical trial design. Ann Surg Oncol. 2013;20:2787–95.CrossRefPubMedGoogle Scholar
  26. 26.
  27. 27.
    Nishida K, Kaneko T, Yoneda M, Nakagawa S, Ishikawa T, Yamane E, et al. Doubling time of serum CA 19-9 in the clinical course of patients with pancreatic cancer and its significant association with prognosis. J Surg Oncol. 1999;71:140–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Estrategia en Cáncer del Sistema Nacional de Salud. Ministerio de Sanidad y Política Social (2010) http://www.msssi.gob.es/organizacion/sns/planCalidadSNS/pdf/ActualizacionEstrategiaCancer.pdf. Accessed Sept 18, 2015.
  29. 29.
    Valderrama-Gama E, Damián J, Guallar E, Rodriguez-Mañas L, et al. Previous disability as a predictor of outcomes in a geriatric rehabilitation unit. J Gerontology. 1998;53:405–9.Google Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2017

Authors and Affiliations

  1. 1.Department of Medical OncologyHospital Universitario Ramón y CajalMadridSpain
  2. 2.Department of RadiologyHospital Universitario Ramón y Cajal, Madrid and Hospital MD AndersonMadridSpain
  3. 3.Department of Medical OncologyComplejo Hospitalario de GranadaGranadaSpain
  4. 4.Pancreatic Unit, Gastroenterology DepartmentHospital General Universitario de AlicanteAlicanteSpain
  5. 5.Department of PathologyCentro AnatomopatológicoMadridSpain

Personalised recommendations