[The S3 guideline exocrine pancreatic cancer]

Each year about 13,000 patients are diagnosed with pancreatic cancer in Germany. More than 95% of all pancreatic cancers are ductal adenocarcinomas and originate from malignant transformation of the exocrine pancreas. There is good evidence that ductal pancreatic cancer develops from so-called PanIn lesions of the ductal epithelium (for pancreatic intraepithelial neoplasia). Males and females are affected at a similar rate. In the German cancer registry, ductal pancreatic cancer incidence is ninth in males and seventh in females. Ductal pancreatic cancer is mostly diagnosed at a late stage. This is due to a lack of early symptoms. The tumor is rather refractory to chemo- or radiotherapy. Only R0 resection of the tumor bears a chance of cure. The unfavorable prognosis of ductal pancreatic cancer is reflected by the fact that pancreatic cancer is the fifth leading cause of cancer death and 5-year survival is only 4%. To assess the current evidence in our understanding of carcinogenesis, diagnosis and treatment of pancreatic cancer, the interdiciplinary S3 guideline "Exocrine pancreatic cancer" was established and published in 2007. The aim of this guideline is to improve early diagnosis of pancreatic cancer, to achieve a higher rate of curative surgery, to prolong survival postoperatively as well as in the palliative setting, to assure a good quality of life, and to improve pain management and nutritional support in supportive care. In the following article the authors will highlight major points of the S3 guideline and point out important developments that have occurred after publication of the guideline.