Bidirectional relationship between acute pancreatitis and pancreatic cancer

Abstract

Purpose of review: The burdens of pancreatic ductal adenocarcinoma (PDAC) and acute pancreatitis are increasing globally. We reviewed current literature on whether acute pancreatitis is a causal factor for PDAC and examined clinical manifestations of PDAC-associated acute pancreatitis.

Recent findings: Recent findings detail the timing of acute pancreatitis before and after PDAC occurrence, further solidifying the evidence for PDAC-associated acute pancreatitis and for acute pancreatitis as a causal risk factor for PDAC. The risk of PDAC remains elevated above the general population in patients with distant history of acute pancreatitis. PDAC risk also increases with recurrent acute pancreatitis episodes, independent of smoking and alcohol. Mechanisms linking acute pancreatitis to PDAC include inflammation and neutrophil infiltration, which can be attenuated by suppressing inflammation and/or epigenetic modulation, thus slowing the progression of acinar-to-ductal metaplasia. Clinical presentation and management of acute pancreatitis in the context of PDAC are discussed, including challenges acute pancreatitis poses in the diagnosis and treatment of PDAC, and novel interventions for PDAC-associated acute pancreatitis.

Summary: PDAC risk may be reduced with improved acute pancreatitis prevention and treatment, such as antiinflammatories or epigenetic modulators. Increased acute pancreatitis and PDAC burden warrant more research on better diagnosis and management of PDAC-associated acute pancreatitis.

Figure 1.. 72 year old man with a 7 year history of acute relapsing pancreatitis

A . Note areas of walled off necrosis in the setting of disconnected pancreatic duct syndrome. B. The patient was treated with dual modality (endoscopic and percutaneous) drainage. Note percutaneous drain and a lumen-apposing metal stent [LAMS] with 2, 7Fr pigtail stents placed into the necrotic cavity. C. Contrast injection through the percutaneous tube 6 weeks later demonstrating ongoing communication to the stomach through the stents and a small residual cavity. D. Following removal of his percutaneous drain, the patient presented 3 months later with pancreatic adenocarcinoma growing through the original percutaneous tract (arrow).