Advances in Early Detection of Pancreatic Cancer

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease. PDAC is the fourth leading cause of death in the United States and Japan based on epidemiological data. Early detection of PDAC is very important to improve the prognosis of PDAC. Early detection of pancreatic ductal adenocarcinoma (PDAC) requires further examination after selecting cases with risk factors for the condition, such as family history, hereditary pancreatic carcinoma syndrome, intraductal papillary mucinous neoplasms, or chronic pancreatitis. The Japan Study Group on the Early Detection of Pancreatic Cancer has investigated and clarified the clinicopathological features for the early diagnosis of PDAC. In Japan, an algorithm for the early diagnosis of PDAC, which utilized the cooperation of local clinics and regional general hospitals, has been a breakthrough in the detection of early-stage PDAC. Further approaches for the early diagnosis of PDAC are warranted.

Keywords: ERCP; PDAC; early stage; pancreatic ductal cell carcinoma.

Figure 1

Overall cancer incidence rate according to affected organ (in Japan). The overall cancer incidence in 2014 was as follows: (1) colorectal cancer, 135,434 cases; (2) gastric cancer, 129,239 cases; (3) lung cancer, 114,550 cases; (4) breast cancer, 78,529 cases; (5) prostate cancer, 74,459 cases; (6) liver cancer, 40,666 cases; and (7) pancreatic carcinoma, 36,239 cases. Thus, pancreatic ductal adenocarcinoma occupies seventh place.

Figure 2

Mortality rate in according to the affected organ (in Japan). The overall numbers of cancer-related deaths in 2016 were as follows: (1) lung cancer, 73,838 cases; (2) colorectal cancer, 50,099 cases; (3) gastric cancer, 45,531 cases; and (4) pancreatic carcinoma, 33,475 cases (men: 17,060 cases, women: 16,415 cases).

Figure 3

A case with high-grade pancreatic intraepithelial neoplasia. (a) Magnetic resonance cholangiopancreatography reveals that the main pancreatic duct is narrowed (arrow) in the pancreatic body and the caudal side pancreatic duct is mildly dilated (arrowhead). (b) Endoscopic retrograde cholangiopancreatography reveals that the main pancreatic duct is locally narrowed (arrow) in the pancreatic body and the caudal side pancreatic duct is mildly dilated (arrowhead). (c) Histopathological imaging reveals intraepithelial cancer in the main pancreatic duct.

Figure 4

Algorithm of pancreatic cancer diagnosis (adopted from Reference [7]).

Figure 5

Concept of cooperation of local clinics and regional hospitals. Networks between local clinics and regional hospitals should be established to detect early-stage pancreatic cancer. EUS, endoscopic ultrasonography; MRCP, magnetic resonance cholangiopancreatography; US, ultrasonography.

Figure 6

Imaging characteristics of early-stage PDAC.