Detecting Early Pancreatic Cancer: Current Problems and Future Prospects

Abstract

The number of patients with pancreatic cancer (PC) is currently increasing in both Korea and Japan. The 5-year survival rate of patients with PC 13.0%; however, resection with minimal invasion (tumor size: ≤10 mm) increases the 5-year survival rate to 80%. For this reason, early detection is essential, but most patients with early-stage PC are asymptomatic. Early detection of PC has been reported to require screening of high-risk individuals (HRIs), such as those with a family history of PC, inherited cancer syndromes, intraductal papillary mucinous neoplasm, or chronic pancreatitis. Studies on screening of these HRIs have confirmed a significantly better prognosis among patients with PC who were screened than for patients with PC who were not screened. However, to date in Japan, most patients with early-stage PC diagnosed in routine clinics were not diagnosed during annual health checks or by surveillance; rather, PC was detected in these patients by incidental findings during examinations for other diseases. We need to increase the precision of the PC screening and diagnostic processes by introducing new technologies, and we need to pay greater attention to incidental clinical findings.

Keywords: Early detection of cancer; Incidental finding; Mass screening; Pancreatic neoplasms; Risk factors.

Fig. 1

Algorithm of the diagnosis and treatment of early pancreatic cancer. US, ultrasonography; EUS, endoscopic ultrasonography; CT, computed tomography; MRI, magnetic resonance imaging; MRCP, magnetic resonance cholangiopancreatography; EUS-FNA, endoscopic ultrasonography guided-fine needle aspiration; ERCP, endoscopic retrograde cholangiopancreatography; ENPD, endoscopic naso-pancreatic drainage.