Pancreatic Cancer in Chronic Pancreatitis: Pathogenesis and Diagnostic Approach
Chronic pancreatitis is one of the main risk factors for pancreatic cancer, but it is a rare event. Inflammation and oncogenes work hand in hand as key promoters of this disease. Tobacco is another co-factor. During alcoholic chronic pancreatitis, the cumulative risk of cancer is estimated at 4% aft...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-01-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/3/761 |
| _version_ | 1797625000292777984 |
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| author | Guillaume Le Cosquer Charlotte Maulat Barbara Bournet Pierre Cordelier Etienne Buscail Louis Buscail |
| author_facet | Guillaume Le Cosquer Charlotte Maulat Barbara Bournet Pierre Cordelier Etienne Buscail Louis Buscail |
| author_sort | Guillaume Le Cosquer |
| collection | DOAJ |
| description | Chronic pancreatitis is one of the main risk factors for pancreatic cancer, but it is a rare event. Inflammation and oncogenes work hand in hand as key promoters of this disease. Tobacco is another co-factor. During alcoholic chronic pancreatitis, the cumulative risk of cancer is estimated at 4% after 15 to 20 years. This cumulative risk is higher in hereditary pancreatitis: 19 and 12% in the case of <i>PRSS1</i> and <i>SPINK1</i> mutations, respectively, at an age of 60 years. The diagnosis is difficult due to: (i) clinical symptoms of cancer shared with those of chronic pancreatitis; (ii) the parenchymal and ductal remodeling of chronic pancreatitis rendering imaging analysis difficult; and (iii) differential diagnoses, such as pseudo-tumorous chronic pancreatitis and paraduodenal pancreatitis. Nevertheless, the occurrence of cancer during chronic pancreatitis must be suspected in the case of back pain, weight loss, unbalanced diabetes, and jaundice, despite alcohol withdrawal. Imaging must be systematically reviewed. Endoscopic ultrasound-guided fine-needle biopsy can contribute by targeting suspicious tissue areas with the help of molecular biology (search for <i>KRAS, TP53, CDKN2A, DPC4</i> mutations). Short-term follow-up of patients is necessary at the clinical and paraclinical levels to try to diagnose cancer at a surgically curable stage. Pancreatic surgery is sometimes necessary if there is any doubt. |
| first_indexed | 2024-03-11T09:50:38Z |
| format | Article |
| id | doaj.art-f8e957ba32324d099c6b55a8ddb1a097 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T09:50:38Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-f8e957ba32324d099c6b55a8ddb1a0972023-11-16T16:16:55ZengMDPI AGCancers2072-66942023-01-0115376110.3390/cancers15030761Pancreatic Cancer in Chronic Pancreatitis: Pathogenesis and Diagnostic ApproachGuillaume Le Cosquer0Charlotte Maulat1Barbara Bournet2Pierre Cordelier3Etienne Buscail4Louis Buscail5Department of Gastroenterology and Pancreatology, CHU Toulouse-Rangueil, University Hospital Centre, Toulouse University, UPS, 31059 Toulouse, FranceDepartment of Digestive Surgery, CHU Toulouse-Rangueil, University Hospital Centre, Toulouse University, UPS, 31059 Toulouse, FranceDepartment of Gastroenterology and Pancreatology, CHU Toulouse-Rangueil, University Hospital Centre, Toulouse University, UPS, 31059 Toulouse, FranceToulouse Cancer Research Center, INSERM U1037, Toulouse University, 31100 Toulouse, FranceInstitut de Recherche en Santé Digestive, Toulouse University, INSERM U1022, INRAe, ENVT, 31300 Toulouse, FranceDepartment of Gastroenterology and Pancreatology, CHU Toulouse-Rangueil, University Hospital Centre, Toulouse University, UPS, 31059 Toulouse, FranceChronic pancreatitis is one of the main risk factors for pancreatic cancer, but it is a rare event. Inflammation and oncogenes work hand in hand as key promoters of this disease. Tobacco is another co-factor. During alcoholic chronic pancreatitis, the cumulative risk of cancer is estimated at 4% after 15 to 20 years. This cumulative risk is higher in hereditary pancreatitis: 19 and 12% in the case of <i>PRSS1</i> and <i>SPINK1</i> mutations, respectively, at an age of 60 years. The diagnosis is difficult due to: (i) clinical symptoms of cancer shared with those of chronic pancreatitis; (ii) the parenchymal and ductal remodeling of chronic pancreatitis rendering imaging analysis difficult; and (iii) differential diagnoses, such as pseudo-tumorous chronic pancreatitis and paraduodenal pancreatitis. Nevertheless, the occurrence of cancer during chronic pancreatitis must be suspected in the case of back pain, weight loss, unbalanced diabetes, and jaundice, despite alcohol withdrawal. Imaging must be systematically reviewed. Endoscopic ultrasound-guided fine-needle biopsy can contribute by targeting suspicious tissue areas with the help of molecular biology (search for <i>KRAS, TP53, CDKN2A, DPC4</i> mutations). Short-term follow-up of patients is necessary at the clinical and paraclinical levels to try to diagnose cancer at a surgically curable stage. Pancreatic surgery is sometimes necessary if there is any doubt.https://www.mdpi.com/2072-6694/15/3/761chronic pancreatitispancreatic ductal adenocarcinomascreeningalcohol consumptiontobacco consumptionhereditary pancreatitis |
| spellingShingle | Guillaume Le Cosquer Charlotte Maulat Barbara Bournet Pierre Cordelier Etienne Buscail Louis Buscail Pancreatic Cancer in Chronic Pancreatitis: Pathogenesis and Diagnostic Approach Cancers chronic pancreatitis pancreatic ductal adenocarcinoma screening alcohol consumption tobacco consumption hereditary pancreatitis |
| title | Pancreatic Cancer in Chronic Pancreatitis: Pathogenesis and Diagnostic Approach |
| title_full | Pancreatic Cancer in Chronic Pancreatitis: Pathogenesis and Diagnostic Approach |
| title_fullStr | Pancreatic Cancer in Chronic Pancreatitis: Pathogenesis and Diagnostic Approach |
| title_full_unstemmed | Pancreatic Cancer in Chronic Pancreatitis: Pathogenesis and Diagnostic Approach |
| title_short | Pancreatic Cancer in Chronic Pancreatitis: Pathogenesis and Diagnostic Approach |
| title_sort | pancreatic cancer in chronic pancreatitis pathogenesis and diagnostic approach |
| topic | chronic pancreatitis pancreatic ductal adenocarcinoma screening alcohol consumption tobacco consumption hereditary pancreatitis |
| url | https://www.mdpi.com/2072-6694/15/3/761 |
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