Pancreatic Cancer Diagnostics and Treatment – Current State

Abstract

Pancreatic ductal adenocarcinoma (PDAC) represents permanent and ever rising issue worldwide. Five-year survival does not exceed 3 to 6%, i.e. the worst result among solid tumours. The article evaluates the current state of PDAC diagnostics and treatment specifying also development and trends. Percentage of non-resectable tumours due to locally advanced or metastatic condition varies 60-80%, mostly over 80%. Survival with non-resectable PDAC is 4 to 8 months (median 3.5). In contrast R0 resection shows the survival 18-27 months. Laboratory and imaging screening methods are not indicated on large scale. Risk factors are smoking, alcohol abuse, chronic pancreatitis, diabetes mellitus. Genetic background in most PDAC has not been detected yet. Some genes connected with high risk of PDAC (e.g. BRCA2, PALB2) have been identified as significant and highly penetrative, but link between PDAC and these genes can be seen only in 10-20%. This article surveys perspective oncogenes, tumour suppressor genes, microRNA. Albeit CT is still favoured over other imaging methods, involvement of NMR rises. Surgery prefers the "vessel first" approach, which proves to be justified especially in R0 resection. According to EBM immunotherapy same as radiotherapy are not significant in PDAC treatment. Chemotherapy shows limited importance in conversion treatment of locally advanced or borderline tumours or in case of metastatic spread. Unified procedures cannot be defined due to inhomogenous arrays. Surgical resection is the only chance for curative treatment of PDAC and depends mainly on timely indication for surgery and quality of multidisciplinary team in a high-volume centre.

Systematic literature review of IL-6 as a biomarker or treatment target in patients with gastric, bile duct, pancreatic and colorectal cancer

“…The prognosis is often dismal, particularly for patients with gastric cancer, pancreatic cancer and bile duct cancer, which includes cholangiocarcinoma and gallbladder cancer. The 5-year overall survival (OS) is only 10–20% for gastric cancer [ 7 , 8 ], 15% for bile duct cancer [ 9 ], 3–7% for pancreatic cancer [ 5 , 6 , 10 – 12 ], and 50–65% for colorectal cancer [ 3 , 13 ]. In 2015, colorectal cancer was the second most common cancer in women, third in men, while it is the fourth leading cause of cancer deaths in men and the third in women [ 3 , 14 , 15 ].…”

Mitogen‑activated protein kinase inhibition enhances the antitumor effects of sporamin in human pancreatic cancer cells

“…Despite advances in surgical techniques, chemotherapy and radiotherapy, the long-term survival rate for patients with PC has not significantly increased since 1977 (2). Therefore, further research into alternative therapies for PC, which has fewer associated toxicities, is urgently required.…”

Chidamide Inhibits Aerobic Metabolism to Induce Pancreatic Cancer Cell Growth Arrest by Promoting Mcl-1 Degradation

“…Unfortunately, only 20% of patients with pancreatic cancer are candidates for surgery, with approximately 80% showing metastasis at the initial diagnosis[3], and present chemotherapy and radiotherapy are only marginally efficacious in pancreatic cancer. Gemcitabine based therapy which is the first line treatment for advanced pancreatic cancer, has a poor response rate[4]. Pancreatic cancer therefore remains a challenge to treat with well-tolerated and effective chemotherapies.…”