Diagnosis and management of pancreatic cancer

Pancreatic adenocarcinoma is an aggressive malignancy with the majority of patients dying within one year of diagnosis. While surgical resection with negative margins offers the only hope for cure only a small minority of patients are amenable to resection at the time of diagnosis owing to the propensity for early metastasis. While most advances in the last several decades have revolved around improvements in surgical techniques and postoperative outcomes, some modest inroads have been made with modern chemotherapy. This review discusses the diagnosis and management of pancreatic cancer and highlights some of the current issues. A Medline database search was performed to identify relevant articles using the keywords "pancreatic adenocarcinoma", "diagnosis", "CA19-9", "pancreaticoduodenectomy", "adjuvant therapy", "chemotherapy", and "microRNA". Additional papers were then identified by a manual search of the references from the key articles. While high quality CT is often the only imaging modality needed for preoperative evaluation, magnetic resonance imaging (MRI), cholangiography, and endoscopic ultrasound (EUS) have been utilized for diagnosis, staging, and/ or palliation. The controversies of pylorus preservation, extended lymphadenectomy, and laparoscopic pancreaticoduodenectomy are discussed. Randomized controlled trials regarding the use of 5-fluorouracil and gemcitabine are also reviewed. Early detection and aggressive surgical resection in combination with protocol-driven adjuvant therapy and novel molecular approaches are the only hope for cure. This review summarizes the recent literature on the abovementioned topics.