Introduction
Of all deaths occurring in the United States, pancreatic cancer accounts for more than 6%. The article analyses the most recent techniques in diagnosis and management pancreatic cancer a malignancy with very poor prognosis. Pancreatic cancer has a very low 5-year survival rate with some studies showing levels below 5%. The study was carried out by a group of researchers from China. The study reviewed the current trends in diagnosis and management of pancreatic cancer. The review focused on English and Chinese language articles from online databases. The review was necessary to map out the very modern and current approaches to allow for proper diagnosis and increase the survival rate of those affected through utilization of these advances.
Screening and early detection
Since cancer-specific symptoms in pancreatic cancer are manifested in advanced stages of the disease, it is difficult to diagnose the malignancy in early stages. Because of this, many patients seek help when the malignancy is in its late stages (usually stage IV) making management difficult. Currently, resection of the tumor is the only therapeutic approach that offers cure and in the late stages of the disease it is not performed. The authors propose research into early diagnostic methods to allow for initiation of early intervention to ensure increased survival rates.
Defining populations at high risk
To increase chances of detecting the malignancy in its early stages, screening should be carried out in asymptomatic individuals. Even though this seems like a better approach, the cost of the undertaking would be in mammoth proportions due to the low incidence of this type of cancer in the general population. As such, screening should be aimed at those perceived to be at high risk of having pancreatic cancer. These include those people over the age of 40 and have gastrointestinal symptoms that are not specific; those with family members with pancreatic cancer, and patients who are over 60years and have been recently diagnosed with type 2 diabetes mellitus. Others include those patients with a history of various forms of pancreatitis and patients who smoke. By screening the high risk population, the total cost is reduced and there is an increased chance of diagnosing pancreatic cancer in its initial stages.
Imaging studies
In its early stages, pancreatic cancer presents as a tumor with a size less than 2cm. Due to the small size of the tumor, the current imaging techniques such as Computerized Tomography, Magnetic Resonance Imaging and ultrasound are unable to effectively spot the tumor. However, new imaging techniques able to spot the tumor have been put into use. An example is the use of methods such as endoscopic ultrasound (EUS) and helical CT scans which have been shown to reproducibly spot the pancreatic tumors in cases of suspicion of the occurrence of the tumor in a patient. Even though these methods are promising, they have been shown not to accurately stage the tumors as per the TNM system. With the use of these modern techniques, scientists may in future be able to accurately map and diagnose pancreatic cancers.
Biomarkers
No tumor marker has shown any sufficient accuracy for it to be used as a screening parameter for pancreatic cancer in asymptomatic people. The salivated Lewis blood group antigen CA19-9 is used as a biomarker in monitoring the progress of therapy rather than in screening. This results from the fact that some section of the population cannot secrete CA19-9 since they do not have enzymes needed for its synthesis. In addition, some conditions such as obstructive jaundice lead to an increase in the serum level of CA19-9. Due to these limitations, other biomarkers are needed to allow for precise screening of pancreatic cancer.
Recent studies have shown potential of biomarkers such as carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1), MIC1, carcinoembryonic antigen, alpha-fetoprotein, pancreatic associated antigen (SPan-1), CA50 antigen, DU-PAN-2, alpha4GnT, cytokeratin-19 (CK-19) mRNA, elastase-1, tissue polypeptide antigen and tissue polypeptide-specific antigen. Most of these biomarkers have failed to demonstrate the required levels of specificity for them to be utilized as screening parameters for pancreatic cancer.
A myriad of biomarkers is under research as potential markers pancreatic cancer. These markers require to be thoroughly studied before they can be employed in screening. Identification of markers would bring about early detection of the malignancy allowing for initiation of intervention in the early stages of the disease.
Therapy
Surgery
Surgery is the only management option known to be effective currently. It allows for removal of a section of the affected pancreas and as such offer a chance for survival of the patients. Rates of resection are diminishing due to most patients presenting with advanced tumors.
Drug therapy
As of now the only proven pharmacotherapy modality is the use Gemcitabine. Other agents have been studied but with limited success in the management of advanced pancreatic cancer. Other advances have included design of site specific treatment targeting specific sites at the molecular level. These include blockade of epidermal growth factor, blockade of cyclooxygenase-2 and inhibition of the enzyme farnesyl transferase. Even though these molecular targeted approaches are promising, pharmacotherapy remains the gold standard in management of pancreatic carcinoma. Extensive research is needed in this field to facilitate improvement of survival rates of the patients.
Radiotherapy
Application of adjuvant therapy is still a controversial undertaking. However, emerging studies show that there is decreased rate of recurrence especially with newer radiation delivery systems such as intensity modulated radiation therapy and image-guided radiation therapy. Based on this, it is prudent that radiotherapy is studied further as an option in the management of pancreatic cancer.
Conclusion
Since pancreatic cancer has low rates of survival, research in proper management protocols to ensure increased survival of the patient. In addition, radiation needs to be considered in management of pancreatic cancer especially those with intermediate resectable or unresectable malignancies.