Early Detection of Pancreatic Cancer

Sushil Kumar Garg; Suresh T. Chari


Curr Opin Gastroenterol. 2020;36(5):456-461. 

In This Article

Cystic Precursor Lesions of Pancreatic Cancer

About 15% of pancreatic cancer is considered to arise from mucin-producing cystic lesions of pancreases[10] which include intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN). IPMNs are mucin-producing neoplasms that can arise from the main pancreatic duct (main duct-IPMN) or its side-branches [branch duct (BD-IPMN)], or both (mixed type-IPMN). Epidemiologic risk factors for the development of IPMN include advanced age, history of diabetes, especially on insulin, chronic pancreatitis, and family history of pancreatic cancer.[10] In most patients, the pancreatic cysts are discovered incidentally on abdominal imaging done for unrelated indication or imaging for nonspecific symptoms of abdominal pain or nausea. Symptoms that might be related to IPMN are back pain, obstructive jaundice, and NOD and weight loss, but they are also not very specific. Computed tomography (CT) abdomen pelvis with pancreas protocol can be initial imaging modality that can be used for diagnosis of the pancreatic cyst with an accuracy of about 56–85%. Magnetic resonance (MR) abdomen with magnetic resonance cholangiopancreatography is a better diagnostic modality because of its ability to identify main pancreatic duct connectivity without risk of exposure to ionizing radiation. MCN occur in young women in the distal pancreas. Hence resection is generally recommended at diagnosis.[19] IPMNs with main duct involvement with or without side-branch involvement have a high malignant potential (36–100%),[19] and are recommended to undergo surgical resection at the time of diagnosis. BD-IPMN, on the other hand, have a relatively low malignant potential and are generally followed at varying intervals.[19] However, the challenge here is that BD-IPMNs are very prevalent and one has to differentiate between BD-IPMNs that are likely to progress pancreatic cancer from benign lesions that will never progress to malignancy (non-IPMN) or BD-IPMN that are extremely unlikely to turn malignant. Up to 25% of patients undergoing surgical resection for cystic lesions of the pancreas have benign lesions that would have never progressed to malignancy.[20] Up to 78% of patients with BD-IPMN do not have cancer or high-grade dysplasia at the time of resection.[21]