Postoperative staging of pancreatic cancer

Pancreatic cancer is a devastating disease with a 5-year survival rate of 3%-5%. The mortality of pancreatic cancer is almost identical with its incidence. The vast majority are pancreatic ductal adenocarcinomas. It is typically a tumour of the elderly. The main risk factor is smoking. Clinical and histopathological studies have identified pancreatic cancer precursor lesions. These include pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasia (IPMN) and mucinous cystic neoplasm (MCN). To improve patient prognosis, surgical interventions have become more aggressive, including pancreaticoduodenectomy and more or less radical lymphadenectomy. Following surgery, it is the surgical pathologist who provides valuable information regarding the exact tumour localization, histological tumour type, grading, completeness of resection, nodal status and the presence of precursor lesions. Although many tissue-based prognostic biomarkers have been characterized and can be studied by immunohistochemistry or molecular biological techniques, their impact on patient management and treatment is still limited. More recently proteomic profiling has raised hopes for early cancer detection, thereby improving the prognosis of pancreatic cancer patients.