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Pankreasfrühkarzinom

Early stage pancreatic cancer

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Zusammenfassung

Hintergrund

Das Pankreaskarzinom steht bei den tumorbedingten Todesursachen aktuell an vierter Stelle und wird bis 2020 voraussichtlich die zweithäufigste Todesursache in den USA sein.

Fragestellung

Welche Diagnosemöglichkeiten und Therapiestrategien zur Behandlung eines Pankreasfrühkarzinoms und seiner präkanzerösen Vorstufen können angewandt werden?

Ergebnisse

Eine flächendeckende Vorsorgeuntersuchung ist zur Früherkennung beim Pankreaskarzinom in der Normalbevölkerung nicht sinnvoll. Beim Verdacht auf auf das Vorliegen eines familiären Pankreaskarzinoms oder bei nachgewiesenen sporadischen Keimbahnmutationen mit erhöhtem Erkrankungsrisiko sollte hingegen eine Vorsorgeuntersuchung spätestens ab dem 45. Lebensjahr begonnen werden. Ebenfalls sollte bei Patienten mit einer präkanzerösen Pankreasneoplasie (insbesondere muzinöse Pankreastumoren) eine elektive Pankreas(teil)resektion durchgeführt werden, da hier ein relevantes Risiko für das Vorliegen eines Pankreasfrühkarzinoms besteht. Komplementär zur bildgebenden Diagnostik können möglicherweise zukünftig nichtinvasive, blutbasierte Biomarker wie zirkulierende Tumorzellen, Exosome oder zellfreie Tumor-DNA eingesetzt werden, um ein Pankreaskarzinom bereits im Frühstadium erkennen zu können.

Schlussfolgerung

Die rechtzeitige Diagnose und Behandlung eines Pankreasfrühkarzinoms kann die Prognose der betroffenen Patienten deutlich verbessern.

Abstract

Background

Pancreatic ductal adenocarcinoma (PDAC) represents the fourth most common cause of cancer mortality and it is expected to become the second most common cause of cancer mortality by 2020 in the USA.

Objective

Which strategies for the detection and treatment of an early stage pancreatic adenocarcinoma and its precursor lesions are to be applied?

Results

Currently, there is no effective general screening program for pancreatic cancer due to the low incidence and the lack of an accurate and inexpensive diagnostic method; however, in patients with a positive history of hereditary pancreatic cancer or in patients with a known sporadic germline mutation that is associated with an increased risk of pancreatic cancer, frequent screening is highly recommended to detect and to treat early stage PDAC. Moreover, patients with a precursor lesion for pancreatic cancer (namely a mucinous pancreatic neoplasm) should undergo an oncological pancreatic resection to prevent the development of late stage pancreatic cancer. In future, additional biomarkers from a liquid biopsy, such as circulating tumor cells, exosomes or circulating tumor DNA may improve the early detection of pancreatic cancer.

Conclusion

The early detection and treatment of pancreatic cancer and its precursor lesions can help to improve the dismal prognosis of this aggressive tumor type.

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Authors and Affiliations

  1. Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    C. Kahlert, M. Distler, J. Weitz &  T. Welsch

  2. Institut für Pathologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland

    D. Aust

  3. Tumor- und Normalgewebebank des Universitätskrebszentrums, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland

    D. Aust

  4. Institut für Klinische Genetik, Universitätsklinikum Carl Gustav Carus an der Technische Universität Dresden, Dresden, Deutschland

    L. Gieldon

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  1. C. Kahlert
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Correspondence to T. Welsch.

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Interessenkonflikt

C. Kahlert, M. Distler, D. Aust, L. Gieldon, J. Weitz und T. Welsch geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Die Autoren C. Kahlert und M. Distler haben zu gleichen Teilen zu der Arbeit beigetragen.

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Kahlert, C., Distler, M., Aust, D. et al. Pankreasfrühkarzinom. Chirurg 89, 257–265 (2018). https://doi.org/10.1007/s00104-017-0569-y

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