| 抄録 |
By 2020 pancreatic cancer（PC）is projected to become the 2nd most common cause of cancer death in the US1. The dismal survival of PC（median 6 months）is because it is often diagnosed at an advanced stage. Improving survival will require diagnosis of early pancreatic cancer which can be defined based on resectability, size or curability. Pancreatic cancer progresses from non-invasive precursor lesions to invasive cancer over a variable time period. Challenges to detection of early PC include late onset of symptoms, lack of changes on cross-sectional imaging in early stages, lack of well defined high risk groups for sporadic cancer and absence of a serologic marker of early disease. Retrospective review of CT scans done prior to diagnosis suggests that pancreatic cancer resectability may be significantly improved if detected as few as 6 months before clinical diagnosis. Since pancreatic cancer is relatively uncommon, population will have to be enriched for the disease before invasive testing is done to detect early cancer. The enrichment of the population for PC will have to be done using at least two“sieves”, first would be a cohort of subjects at higher than average risk of PC and the second sieve could be a characteristic phenotype among the members of the high-risk group, an abnormality seen on non-invasive imaging or a serologic marker of early PC. Confirmation of diagnosis will require invasive procedures such endoscopic ultrasonography. So far two high risk groups have been targets of screening for pancreatic cancer, viz., hereditary pancreatic cancer kindreds and new-onset diabetes. Though much work still needs to be done, the developments in the field provide us with hope that screening for early pancreatic cancer could become a reality in the not-so-distant future. |
