Pancreatic cancer

Lancet. 2016 Jul 2;388(10039):73-85. doi: 10.1016/S0140-6736(16)00141-0. Epub 2016 Jan 30.

Abstract

Pancreatic cancer is a highly lethal disease, for which mortality closely parallels incidence. Most patients with pancreatic cancer remain asymptomatic until the disease reaches an advanced stage. There is no standard programme for screening patients at high risk of pancreatic cancer (eg, those with a family history of pancreatic cancer and chronic pancreatitis). Most pancreatic cancers arise from microscopic non-invasive epithelial proliferations within the pancreatic ducts, referred to as pancreatic intraepithelial neoplasias. There are four major driver genes for pancreatic cancer: KRAS, CDKN2A, TP53, and SMAD4. KRAS mutation and alterations in CDKN2A are early events in pancreatic tumorigenesis. Endoscopic ultrasonography and endoscopic ultrasonography-guided fine-needle aspiration offer high diagnostic ability for pancreatic cancer. Surgical resection is regarded as the only potentially curative treatment, and adjuvant chemotherapy with gemcitabine or S-1, an oral fluoropyrimidine derivative, is given after surgery. FOLFIRINOX (fluorouracil, folinic acid [leucovorin], irinotecan, and oxaliplatin) and gemcitabine plus nanoparticle albumin-bound paclitaxel (nab-paclitaxel) are the treatments of choice for patients who are not surgical candidates but have good performance status.

Publication types

  • Review

MeSH terms

  • Albumins / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • CA-19-9 Antigen / metabolism
  • Camptothecin / administration & dosage
  • Camptothecin / analogs & derivatives
  • Carcinoembryonic Antigen / metabolism
  • Carcinoma, Pancreatic Ductal / diagnosis*
  • Carcinoma, Pancreatic Ductal / genetics
  • Carcinoma, Pancreatic Ductal / therapy
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / analogs & derivatives
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration
  • Endosonography
  • Fluorouracil / administration & dosage
  • Genes, p16
  • Humans
  • Irinotecan
  • Leucovorin / administration & dosage
  • Neoplasms, Cystic, Mucinous, and Serous / diagnosis*
  • Neoplasms, Cystic, Mucinous, and Serous / genetics
  • Neoplasms, Cystic, Mucinous, and Serous / therapy
  • Organoplatinum Compounds / administration & dosage
  • Oxaliplatin
  • Paclitaxel / administration & dosage
  • Pancreatectomy
  • Pancreatic Neoplasms / diagnosis*
  • Pancreatic Neoplasms / genetics
  • Pancreatic Neoplasms / therapy
  • Proto-Oncogene Proteins p21(ras) / genetics
  • Smad4 Protein / genetics
  • Tumor Suppressor Protein p53 / genetics

Substances

  • 130-nm albumin-bound paclitaxel
  • Albumins
  • CA-19-9 Antigen
  • Carcinoembryonic Antigen
  • KRAS protein, human
  • Organoplatinum Compounds
  • SMAD4 protein, human
  • Smad4 Protein
  • TP53 protein, human
  • Tumor Suppressor Protein p53
  • Oxaliplatin
  • Deoxycytidine
  • Irinotecan
  • gemcitabine
  • Proto-Oncogene Proteins p21(ras)
  • Paclitaxel
  • Leucovorin
  • Fluorouracil
  • Camptothecin