Pancreatitis as a risk for pancreatic cancer.
Chronic pancreatitis clearly predisposes to pancreatic cancer, with early onset-long duration chronic pancreatitis from cystic fibrosis, TP, and HP conferring the highest risk. Chronic pancreatitis is not a critical step, however, but rather one of several conditions that accelerate the accumulation of critical genetic mutations and chromosomal losses necessary for carcinogenesis. Indeed, other germline mutations, environmental factors such as tobacco smoking and alcohol consumption, or dietary factors may also accelerate the pathway to carcinogenesis, and may be synergistic with the conditions created by chronic pancreatitis. Because patients with chronic pancreatitis are at high risk of pancreatic cancer, the physician is faced with decisions on how to manage this risk. Discontinuing smoking and alcohol consumption, and perhaps dietary modification are obvious recommendations for risk reduction. If, however, the patient is older and already in a very high-risk category (e.g., long-standing HP), then screening for cancers must be considered. Inclusion in multicenter trials is recommended, and information on ongoing studies can be obtained through the office of Dr. Whitcomb, or as posted on www.pancreas.org.
Department of Medicine, University of Pittsburgh, UPMC Presbyterian, Mezzanine Level, C Wing, 200 Lothrop Street, Pittsburgh, PA 15213, USA. whitcomb@pitt.edu
David C
DC
Whitcomb
Katherine
K
Pogue-Geile
D002471:Cell Transformation, Neoplastic; D004777:Environment; D020022:Genetic Predisposition to Disease; D015438:Health Behavior; D006801:Humans; D008403:Mass Screening / Q000379:methods; D009154:Mutation; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D010195:Pancreatitis / Q000150:complications* / Q000235:genetics; D012307:Risk Factors