Published online Aug 28, 2014. doi: 10.3748/wjg.v20.i32.11241
Revised: March 2, 2014
Accepted: June 2, 2014
Published online: August 28, 2014
Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal forms of cancer. Substantial progress has been made in the understanding of the biology of pancreatic cancer, and advances in patient management have been significant. However, most patients (nearly 80%) who present with locally advanced or metastatic disease have an extremely poor prognosis. Survival is better for those with malignant disease localized to the pancreas, because surgical resection at present offers the only chance of cure. Therefore, the early detection of pancreatic cancer may benefit patients with PDAC. However, its low rate of incidence and the limitations of current screening strategies make early detection difficult. Recent advances in the understanding of the pathogenesis of PDAC suggest that it is possible to detect PDAC in early stages and even identify precursor lesions. The presence of new-onset diabetes mellitus in the early phase of pancreatic cancer may provide clues for its early diagnosis. Advances in the identification of novel circulating biomarkers including serological signatures, autoantibodies, epigenetic markers, circulating tumor cells and microRNAs suggest that they can be used as potential tools for the screening of precursors and early stage PDAC in the future. However, proper screening strategies based on effective screening methodologies need to be tested for clinical application.
Core tip: Because pancreatic cancer is usually detected at an advanced stage and there is a lack of treatment strategies for advanced disease, it remains one of the most lethal solid tumors. Genetic and epigenetic alterations, miRNAs and tumor microenvironment promote the development of pancreatic cancer from precursor lesions to localized disease and further to metastatic disease in several years. An effective screening strategy for pancreatic cancer is therefore needed. New-onset diabetes mellitus associated with pancreatic cancer and recently identified novel circulating biomarkers should be explored as potential screening markers.