Pancreatic neoplasms

Pancreatic cancer is an important cause of cancer death in industrialized countries. There is an increased risk of developing pancreatic cancer in chronic pancreatitis, especially hereditary pancreatitis. Progressive accumulation of genetic mutations in oncogenes (eg, K-ras) and tumor suppressor genes (eg, p16, DPC4, p53) probably leads to neoplastic transformation of pancreatic ductal cells. CA 19-9 is the best available pancreatic tumor marker and may be useful to followup patients after therapy. Accurate prediction of resectability using helical computed tomography may depend on technique, protocol, and criteria used. Results of traditional adjuvant chemoradiation therapy have not produced dramatic improvements in 5-year survival. Early spread of tumor through lymph nodes and intrapancreatic nerves might explain the almost invariable recurrence after surgery. Cancer gene therapy shows promise in in vitro and animal studies. Endoscopic ultrasound may be a valuable tool to differentiate various types of cystic pancreatic tumors. Among imaging tests for gastrinomas, somatostatin receptor scintigraphy is the most sensitive. There is an explosion of interest in pancreatic cancer and the increasing understanding of the tumor biology should lead to early diagnosis and better therapy for all stages of pancreatic cancer.