The actual management of early pancreatic cancer

Pancreatic cancer (PC) is a highly lethal disease. Early diagnosis remains the only possibility nowadays for an intention to cure the disease, since prognosis of PC is significantly better in patients diagnosed of small (<2 cm), well differentiated, stages I and II pancreatic tumors. However, the best approach would be to detect precursor lesions, like Intraductal papillary mucinous neoplasm (IPMN) or PanIN lesions. In this setting the best technique to diagnose either small PC and/or IPMN and PanIN lesions is clearly endoscopic ultrasound. However, detection of these lesions is very difficult, hampered by the absence of clinical manifestations of PC at these early stages. The implementation of screening programs, which - given the incidence of PC - is not cost effective for the general population, in high-risk individuals, may lead to increase the detection of PC an early stages as well as precursor lesion. When focusing on treatment, PC patients are best cared by multidisciplinary teams. For patients with resectable disease surgery remains the treatment of choice, followed by postoperative treatment. When precursor lesions are detected, mainly IPMN, treatment should be individualized, following latest international guidelines.