Pancreatic Cancer Screening: State of the Art

Christian Gemmel; Axel Eickhoff; Lars Helmstädter; Jürgen F Riemann

Disclosures

Expert Rev Gastroenterol Hepatol. 2009;3(1):89-96. 

In This Article

Five-year View

We anticipate that pancreatic cancer screening will become standard for high-risk individuals. International studies are currently underway to investigate novel markers for IPMNs, PanIN-3 lesions or microinvasive adenocarcinoma in pancreatic juice, serum and tumor tissue. Early detection could allow such lesions to be resected before they develop into pancreatic cancer.

Molecular-based strategies could help to elucidate the molecular basis of pancreatic tumor growth and genesis and may offer new techniques of individual screening.[77,78] The development of proteomics technologies offers great promises for the discovery of new pancreatic-cancer biomarkers.[79] So far, a variety of biomarkers and DNA/RNA markers can be used to detect pancreatic cancer and are likely to provide promising new methods and treatment options.[80,81,82,83,84]

However, these molecular techniques are still in their infancy and require further controlled studies in order to prove its clinical effectiveness and applicability in the setting of pancreatic cancer.

Further research is required to determine what proportion of patients at risk develops cancer via each pathway and whether resection of localized lesions, such as IPMNs and MCNs, will prevent cancer from developing in the remaining pancreas. Further studies should be directed at methods with regards to pancreatic cancer risk stratification. For instance, special EUS and CT criteria for determining the severity of chronic pancreatitis or other specific features may be potential risk predictors.

Multiprospective studies are needed to determine whether screening for early pancreatic neoplasia and timely intervention results in a decreased incidence and mortality for pancreatic cancer in high-risk individuals.

A combined approach of highly sensitive and specific tests for serum and genetic markers and specific imaging studies may prove to be the future of pancreatic screening in the author"s point of view and may lead to the formulation of a powerful and effective screening protocol that is yet to be established.

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