Skip to main content

Advertisement

Log in

Pancreatic cancer: Can we screen? How should we stage?

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Pancreatic cancer remains a deadly disease, with few patients surviving 5 years following diagnosis. Surgical resection remains the only treatment associated with the potential for cure; however, most patients have locally advanced or metastatic disease at presentation and thus are not surgical candidates. Advances in imaging technologies, biochemistry, and molecular genetics have raised hopes of improving the outcome for patients with pancreatic cancer through earlier and more accurate diagnosis. As our knowledge of the genetics of pancreatic cancer has increased, the possibility of screening to identify patients at risk to develop the disease also holds promise. This review focuses on the utility of current modalities to screen for pancreatic cancer as well as the most accurate and expedient methods to stage the disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. American Cancer Society: Cancer statistics 1996. CA Cancer J Clin. 1996, 46:9–16.

    Google Scholar 

  2. Warshaw AL, Castillo CF: Pancreatic carcinoma. N Engl J Med 1992, 326:45–65.

    Article  Google Scholar 

  3. US Preventive Services Task Force: Guide to Clinical Preventive Services. Baltimore: Williams and Wilkins; 1996:67–173.

    Google Scholar 

  4. Ariyama J, Suyama M, Satoh K, Sai J: Imaging of small pancreatic ductal adenocarcinoma. Pancreas. 1998, 16:396–401.

    Article  PubMed  CAS  Google Scholar 

  5. Tanaka S, Kitamura T: Evaluation of routine sonography for early detection of pancreatic cancer. Jpn J Clin Oncol. 1996, 26:422–427.

    PubMed  CAS  Google Scholar 

  6. Flanders TY, Foulkes WD: Pancreatic adenocarcinoma: epidemiology and genetics. J Med Genet. 1996, 33:889–898.

    Article  PubMed  CAS  Google Scholar 

  7. Safi F, Schlosser W, Falkenreck S, Beger HG: Prognostic value of CA 19-9 serum course in pancreatic cancer. Hepatogastroenterology 1998, 45:253–259. Serum expression of CA19-9 was examined in a large cohort of pancreatic cancer patients. Its utility in diagnosis, prognosis, and surveillance is thoroughly analyzed and discussed.

    PubMed  CAS  Google Scholar 

  8. Satake K, Takeuchi T, Homma T, Ozaki H: CA-19-9 as a screening and diagnostic tool in symptomatic patients: the Japanese experience. Pancreas. 1994, 9:703–706.

    Article  PubMed  CAS  Google Scholar 

  9. Satake K, Takeuchi T: Comparison of CA 19-9 with other tumor markers in the diagnosis of cancer of the pancreas. Pancreas. 1994, 9:720–724.

    Article  PubMed  CAS  Google Scholar 

  10. Frebourg T, Bercoff E, Manchon N, et al.: The evaluation of CA 19-9 antigen level in the early detection of pancreatic cancer: a prospective study of 866 patients. Cancer. 1988, 62:2287–2290.

    Article  PubMed  CAS  Google Scholar 

  11. Tokoo M, Oguci H, Kawa S, et al.: Mass survey for pancreatic cancer using measurement of serum markers: a case of resectable pancreatic tail cancer detected. Pancreas. 1990, 5:156–160.

    Google Scholar 

  12. Chari S, Klee CG, Miller LJ, et al.: Sensitivity and specificity of CA 19-9 and islet amyloid polypeptide (IAPP) for symptomatic pancreatic cancer (PC). Pancreas. 1998, 17:429–433.

    Google Scholar 

  13. Nakaizumi A, Tatsuta M, Uehara H, et al.: A prospective trial of early detection of pancreatic cancer by ultrasonographic examination combined with measurement of serum elastase 1. Cancer. 1992, 69:936–940.

    Article  PubMed  CAS  Google Scholar 

  14. Ghadirian P, Baillargeon J, Simard A, Perret C: Food habits and pancreatic cancer: a case control study of the francophone community in Montreal, Canada. Cancer Epidemiol Biomarkers Prev. 1995, 4:895–899.

    PubMed  CAS  Google Scholar 

  15. Gold EB: Epidemiology of and risk factors for pancreatic cancer. Surg Clin North Am. 1995, 75:819–843.

    PubMed  CAS  Google Scholar 

  16. Connolly MM, Dawson PJ, Michelassi F, et al.: Survival in 1001 patients with carcinoma of the pancreas. Ann Surg. 1987, 206:366–373.

    Article  PubMed  CAS  Google Scholar 

  17. Lumadue JA, Griffin CA, Osman M, Hruban RH: Familial pancreatic cancer and the genetics of pancreatic cancer. Surg Clin North Am. 1995, 75:845–855.

    PubMed  CAS  Google Scholar 

  18. Whitcomb DC, Gorry MC, Preston RA, et al.: Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene. Nat Genet. 1996,14:141–145.

    Article  PubMed  CAS  Google Scholar 

  19. Lowenfels AB, Maisonneuve P, DiMagno EP, et al.: Hereditary pancreatitis and the risk of pancreatic cancer. J Natl Cancer Inst. 1997, 89:442–446.

    Article  PubMed  CAS  Google Scholar 

  20. Goggins M, Schutte M, Lu J, et al.: Germline BRCA2 gene mutations in patients with apparently sporadic pancreatic carcinomas. Cancer Res. 1996, 56:5360–5364.

    PubMed  CAS  Google Scholar 

  21. Kern SE: Advances from genetic clues in pancreatic cancer. Curr Opin Oncol. 1998, 10:74–80. The author provides an excellent review of the known molecular events associated with pancreatic carcinoma.

    Article  PubMed  CAS  Google Scholar 

  22. Lynch HT: Genetics and pancreatic cancer. Arch Surg. 1994, 129:266–268.

    PubMed  CAS  Google Scholar 

  23. Furuya N, Kawa S, Akamatsu T, Furihata K: Long-term followup of patients with chronic pancreatitis and K-ras gene mutation detected in pancreatic juice. Gastroenterology. 1997, 113:593–598.

    Article  PubMed  CAS  Google Scholar 

  24. Hiyama E, Kodama T, Shinbara K, et al.: Telomerase activity is detected in pancreatic cancer but not in benign tumors. Cancer Res. 1997, 57:326–331. Telomerase activity is demonstrated to be specific to malignant versus benign pancreatic neoplasms. The potential use of this nongenetic assay for early detection of pancreatic cancers is described.

    PubMed  CAS  Google Scholar 

  25. Warshaw AL, Gu Z, Wittenberg J, Waltman AC: Preoperative staging and assessment of resectability of pancreatic cancer. Arch Surg. 1990, 125:230–233.

    PubMed  CAS  Google Scholar 

  26. Cuesta MA, Meijer S, Borgstein PJ, et al.: Laparoscopic ultrasonography for hepatobiliary and pancreatic malignancy. Br J Surg. 1993, 80:1571–1574.

    Article  PubMed  CAS  Google Scholar 

  27. Conlon KC, Dougherty E, Klimstra DS, et al.: The value of minimal access surgery in the staging of patients with potentially resectable peripancreatic malignancy. Ann Surg. 1996, 223:134–140.

    Article  PubMed  CAS  Google Scholar 

  28. Merchant NB, Conlon KC: Laparoscopic evaluation in pancreatic cancer. Semin Surg Oncol. 1998, 15:155–165. The authors provide an overview of the utility of laparoscopic staging for pancreatic cancer.

    Article  PubMed  CAS  Google Scholar 

  29. Willett CG, Lewandrowski K, Warshaw AL, et al.: Resection margins in carcinoma of the head of the pancreas: implications for radiation therapy. Ann Surg. 1993, 217:144–148.

    Article  PubMed  CAS  Google Scholar 

  30. Leach SD, Lee JE, Charnsangavej C, et al.: Survival following pancreaticoduodenectomy with resection of the superior mesenteric-portal vein confluence for adenocarcinoma of the pancreatic head. Br J Surg. 1998, 85:611–617. Data from this study suggest that isolated involvement of the PV-SMV should not represent a contraindication to pancreaticoduodenectomy. The authors present an excellent discussion of the surgical and staging issues relevant to this controversy.

    Article  PubMed  CAS  Google Scholar 

  31. Harrison LE, Klimstra DS, Brennan MF: Isolated portal vein involvement in pancreatic adenocarcinoma: a contraindication for resection? Ann Surg. 1996, 224:342–349.

    Article  PubMed  CAS  Google Scholar 

  32. Brambs HJ, Claussen CD: Pancreatic and ampullary carcinoma: ultrasound, computed tomography, magnetic resonance imaging and angiography. Endoscopy. 1993, 25:58–68.

    Article  PubMed  CAS  Google Scholar 

  33. Brand RE, Matamoros A: Imaging techniques in the evaluation of adenocarcinoma of the pancreas. Dig Dis. 1998, 16:242–252.

    Article  PubMed  CAS  Google Scholar 

  34. Yassa NA, Yang J, Stein S, et al.: Gray-scale and color flow sonography of pancreatic ductal adenocarcinoma. J Clin Ultrasound. 1997, 25:473–480.

    Article  PubMed  CAS  Google Scholar 

  35. Wren SM, Ralls PW, Stain SC, et al.: Assessment of resectability of pancreatic head and periampullary tumors by color flow doppler sonography. Arch Surg. 1996, 131:812–818.

    PubMed  CAS  Google Scholar 

  36. Stephens DH: CT of pancreatic neoplasms. Curr Probl Diagn Radiol. 1997, 26:59–80.

    PubMed  CAS  Google Scholar 

  37. McCarthy MJ, Evans J, Sagar G, Neoptolemos JP: Prediction of resectability of pancreatic malignancy by computed tomography. Br J Surg. 1998, 85:320–325.

    Article  PubMed  CAS  Google Scholar 

  38. Freeny PC, Traverso LW, Ryan JA: Diagnosis and staging of pancreatic adenocarcinoma with dynamic computed tomography. Am J Surg. 1993, 165:600–606.

    Article  PubMed  CAS  Google Scholar 

  39. Fuhrman GM, Charnsangavej C, Abbruzzese JL, et al.: Thin-section contrast-enhanced computed tomography accurately predicts the resectability of malignant pancreatic neoplasms. Am J Surg. 1994, 167:104–113.

    Article  PubMed  CAS  Google Scholar 

  40. Rivera JA, Fernandez-del Castillo C, Warshaw AL: The preoperative staging of pancreatic adenocarcinoma. Adv Surg. 1997, 30:97–122.

    Google Scholar 

  41. Savader BL, Fishman EK, Savader SJ, Cameron JL: CT arterial portography vs pancreatic arteriography in the assessment of vascular involvement in pancreatic and periampullary tumors. J Comput Assist Tomogr. 1994, 18:916–920.

    Article  PubMed  CAS  Google Scholar 

  42. Ichikawa T, Haradome H, Hachiya J, et al.: Pancreatic ductal adenocarcinoma: preoperative assessment with helical CT versus dynamic MR imaging. Radiology. 1997, 202:655–662.

    PubMed  CAS  Google Scholar 

  43. Furukawa H, Kosuge T, Mukai K, et al.: Helical computed tomography in the diagnosis of portal vein invasion by pancreatic head carcinoma. Arch Surg. 1998, 133:61–65.

    Article  PubMed  CAS  Google Scholar 

  44. Lu DS, Vedantham S, Krasny RM, et al.: Two-phase helical CT for pancreatic tumors: pancreatic versus hepatic phase enhancement of tumor, pancreas, and vascular structures. Radiology. 1996, 199:697–701.

    PubMed  CAS  Google Scholar 

  45. Zeman RK, Cooper C, Zeiberg AS, et al.: TNM staging of pancreatic carcinoma using helical CT. Am J Roentgenol. 1997, 169:459–464.

    CAS  Google Scholar 

  46. Diehl SJ, Lehmann KJ, Sadick M, et al.: Pancreatic cancer: value of dual-phase helical CT in assessing resectability. Radiology 1998, 206:373–378.

    PubMed  CAS  Google Scholar 

  47. Legmann P, Vignaux O, Dousset B, et al.: Pancreatic tumors: comparison of dual-phase helical CT and endoscopic sonography. Am J Roentgenol. 1998, 170:1315–1322. The authors provide a prospective comparison of dual-phase helical CT and EUS, with excellent photographs displaying the capabilities of these two imaging modalities.

    CAS  Google Scholar 

  48. Irie H, Honda H, Kaneko K, et al.: Comparison of helical CT and MR imaging in detecting and staging small pancreatic adenocarcinoma. Abdom Imaging. 1997, 22:429–433.

    Article  PubMed  CAS  Google Scholar 

  49. Sironi S, De Cobelli F, Zerbi A, et al.: Pancreatic carcinoma: MR assessment of tumor invasion of the peripancreatic vessels. J Comput Assist Tomogr. 1995, 19:739–744.

    Article  PubMed  CAS  Google Scholar 

  50. Sironi S, De Cobelli F, Zerbi A, et al.: Pancreatic adenocarcinoma: assessment of vascular invasion with high-field MR imaging and a phased-array coil. Am J Roentgenol. 1996, 167:997–1001.

    CAS  Google Scholar 

  51. McFarland EG, Kaufman JA, Saini S, et al.: Preoperative staging of cancer of the pancreas: value of MR angiography versus conventional angiography in detecting portal venous invasion. Am J Roentgenol. 1996, 166:37–43.

    CAS  Google Scholar 

  52. Palazzo L, Roseau G, Gayet B, et al.: Endosonographic ultrasonography in the diagnosis and staging of pancreatic adenenocarcinoma. Endoscopy. 1993, 25:143–150.

    Article  PubMed  CAS  Google Scholar 

  53. Nakaizumi A, Uehara H, Iishi H, et al.: Endoscopic ultrasonography in the diagnosis and staging of pancreatic cancer. Dig Dis Sci. 1995, 40:696–700.

    Article  PubMed  CAS  Google Scholar 

  54. Brugge WR, Lee MJ, Kelsey PB, et al.: The use of EUS to diagnose malignant portal venous system invasion by pancreatic cancer. Gastrointest Endosc. 1996, 43:561–567.

    Article  PubMed  CAS  Google Scholar 

  55. Gress F, Savides T, Cummings O, et al.: Radial scanning and linear array endosonography for staging pancreatic cancer: a prospective randomized comparison. Gastrointest Endosc 1997, 45:138–142. This is a well-conceived study of EUS in the staging of pancreatic cancer.

    Article  PubMed  CAS  Google Scholar 

  56. Chang KJ, Nguyen P, Erickson RA, et al.: The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc. 1997, 45:387–393.

    Article  PubMed  CAS  Google Scholar 

  57. Bhutani MS, Hawes RH, Baron PL, et al.: Endoscopic ultrasound guided fine needle aspiration of malignant pancreatic lesions. Endoscopy. 1997, 29:854–858.

    Article  PubMed  CAS  Google Scholar 

  58. Fernandez-del Castillo C, Rattner DW, Warshaw AL: Further experience with laparoscopy and peritoneal cytology in the staging of pancreatic cancer. Br J Surg. 1995, 82:1127–1129.

    Article  PubMed  CAS  Google Scholar 

  59. Warshaw AL, Tepper JE, Shipley WU: Laparoscopy in the staging and planning of therapy for pancreatic cancer. Am J Surg 1986, 151:76–80.

    Article  PubMed  CAS  Google Scholar 

  60. Friess H, Kleff J, Silva JC: The role of diagnostic laparoscopy in pancreatic and periampullary malignancies. J Am Coll Surg 1998, 186:675–682.

    Article  PubMed  CAS  Google Scholar 

  61. John TG, Greig JD, Carter DC, Garden OJ: Carcinoma of the pancreatic head and periampullary region: tumor staging with laparoscopy and laparoscopic ultrasonography. Ann Surg. 1995, 221:156–164.

    Article  PubMed  CAS  Google Scholar 

  62. Bemelman WA, de Wit LT, van Delden OM, et al.: Diagnostic laparoscopy combined with laparoscopic ultrasonography in staging of cancer of the pancreatic head region. Br J Surg 1995, 82:820–824.

    Article  PubMed  CAS  Google Scholar 

  63. Warshaw AL: Implications of peritoneal cytology for staging of early pancreatic cancer. Am J Surg. 1991, 161:26–30.

    Article  PubMed  CAS  Google Scholar 

  64. Leach SD, Rose JA, Lowy AM, et al.: Significance of peritoneal cytology in patients with potentially resectable adenocarcinoma of the pancreatic head. Surgery. 1995, 118:472–478.

    Article  PubMed  CAS  Google Scholar 

  65. Lei S, Kini J, Kim K, Howard JM: Pancreatic cancer: cytologic study of peritoneal washings. Arch Surg. 1994, 129:639–642.

    PubMed  CAS  Google Scholar 

  66. Inokuma T, Tamaki N, Torizuka T, et al.: Evaluation of pancreatic tumors with positron emission tomography and F-18 fluorodeoxyglucose: comparison with CT and US. Radiology 1995, 195:345–352.

    PubMed  CAS  Google Scholar 

  67. Stollfuss JC, Glatting G, Friess H, et al.: 2-(Fluorine-18)-Fluoro-2-Deoxy-D-glucose PET in detection of pancreatic cancer: value of quantitative image interpretation. Radiology. 1995, 195:339–344.

    PubMed  CAS  Google Scholar 

  68. Freiss H, Langhans J, Ebert M, et al.: Diagnosis of pancreatic cancer by 2(18F)-fluoro-2-deoxy-D-glucose positron emission tomography. Gut. 1995, 36:771–777.

    Article  Google Scholar 

  69. Ritts RE, Nagorney DM, Jacobsen DJ, et al.: Comparison of preoperative serum CA19-9 levels with results of diagnostic imaging modalities in patients undergoing laparotomy for suspected pancreatic or gallbladder disease. Pancreas. 1994, 9:707–716.

    Article  PubMed  Google Scholar 

  70. Forsmark CE, Lambiase L, Vogel S: Diagnosis of pancreatic cancer and prediction of unresectability using the tumorassociated antigen CA19-9. Pancreas. 1994, 9:731–734.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Parikh, A.A., Lowy, A.M. Pancreatic cancer: Can we screen? How should we stage?. Curr Gastroenterol Rep 1, 166–174 (1999). https://doi.org/10.1007/s11894-996-0017-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-996-0017-5

Keywords

Navigation