Management of pancreatic cancer

Abstract

Pancreatic cancer, irrespective of disease stage, remains among the most lethal malignancies of the Western world, with a 1-year survival rate of 25% and a 5-year survival rate of less than 5%. During 2013 alone, it is expected that 43,920 new cases of pancreatic cancer will be diagnosed and 37,390 deaths will occur in the United States as a result of pancreatic cancer. In spite of these appalling statistics, recent improvements in understanding of predisposing risk factors, coordination of care among different specialties, and both palliative and curative treatment approaches offer promise for earlier detection and therapy that is not only more effective but also more amenable to maintaining a high quality of life. In this issue of Current Problems in Cancer, we outline the latest advancements in the management of pancreatic cancer with a particular focus on how the gathering of multiple disciplines, such as endocrinology, gastroenterology, anesthesiology, immunology, and others, under the widening umbrella of pancreatic oncology practice has enhanced patient care. In stark contrast to the death rates for other leading causes of cancer death (lung, colorectal, breast, and prostate), which have declined since 2003, the mortality rate from pancreatic adenocarcinoma has increased during the same time period. Therefore, early detection, diagnosis, and accurate stratification of patients with pancreatic mass lesions are paramount in providing timely, optimal care. Identification of risk factors for this devastating cancer may enhance our understanding of pancreatic tumorigenesis and lead to the advent of more sensitive, specific, and cost-effective screening methods that would render detection of curablestage disease more commonly achievable. Preexisting type 2 diabetes mellitus has been suggested to be associated with an increased risk of developing pancreatic cancer. Possible mechanisms underlying this association include chronic hyperglycemia, hyperinsulinemia, and insulin resistance. Similarly, obesity has emerged as an independent risk factor for pancreatic cancer. Metformin appears to decrease the incidence of pancreatic cancer, whereas insulin use may be associated with increased risk. In the opening article of this issue of Current Problems in Cancer, the epidemiologic and pathophysiological significance of these findings is discussed by Chaudhry and colleagues in a comprehensive review of the relationship between glucose metabolism and pancreatic cancer. In the second feature of this issue, we move from predisposing risk factors into the practical means of diagnosing this disease. In recent years, endoscopic interventions have emerged as increasingly important diagnostic and therapeutic tools in the diagnosis and management of patients with pancreatic cancer. Accordingly, Shin and colleagues provide a detailed account of