title: The early diagnosis of pancreatic cancer and diabetes: what's the relationship?
abstract: Pancreatic cancer (PC) has a dismal prognosis as cancer-specific symptoms occur only at an advanced stage. If the cancer is to be discovered early, it will have to be done in asymptomatic individuals. Since the incidence of PC is low, screening for asymptomatic cancer in the general population will not be feasible. Screening will have to be restricted to subjects at high risk for PC. The proportion of PC patients who also have hyperglycemia or diabetes has previously been under appreciated; new data show that up to 80% are either hyperglycemic or diabetic and this can be evident in the pre-symptomatic phase. Diabetes improves following PC resection suggesting that diabetes is caused by the cancer. Conversely, older subjects with new-onset diabetes have an approximately eight fold higher risk of having PC compared to the general population. Recognition of new-onset diabetes as an early manifestation of PC could lead to diagnosis of asymptomatic, early stage PC. However, primary type 2 diabetes is common and PC is relatively uncommon in the general population and the two forms of diabetes are clinically indistinguishable. The success of the strategy to use new-onset hyperglycemia and diabetes as a screening tool to identify subjects with a high likelihood of having asymptomatic PC will depend largely on our ability to differentiate PC-associated diabetes from the more common type 2 diabetes using a (serologic) biomarker.
authors.affiliation: 1 Clinical Oncology Laboratory, Changzhou Cancer Hospital of Soochow University, Changzhou 213002, China ; 2 The Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200433, China ; 3 The Hepatic Surgery Center, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China ; 4 The Hepatobiliary Surgery Centre, The Ningbo No. 2 Hospital, Ningbo 315010, China.
authors.forename: Changsong
authors.initials: C
authors.lastname: Zhang
authors.affiliation: 1 Clinical Oncology Laboratory, Changzhou Cancer Hospital of Soochow University, Changzhou 213002, China ; 2 The Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200433, China ; 3 The Hepatic Surgery Center, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China ; 4 The Hepatobiliary Surgery Centre, The Ningbo No. 2 Hospital, Ningbo 315010, China.
authors.forename: Guangshun
authors.initials: G
authors.lastname: Yang
authors.affiliation: 1 Clinical Oncology Laboratory, Changzhou Cancer Hospital of Soochow University, Changzhou 213002, China ; 2 The Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200433, China ; 3 The Hepatic Surgery Center, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China ; 4 The Hepatobiliary Surgery Centre, The Ningbo No. 2 Hospital, Ningbo 315010, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Ling
authors.affiliation: 1 Clinical Oncology Laboratory, Changzhou Cancer Hospital of Soochow University, Changzhou 213002, China ; 2 The Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200433, China ; 3 The Hepatic Surgery Center, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China ; 4 The Hepatobiliary Surgery Centre, The Ningbo No. 2 Hospital, Ningbo 315010, China.
authors.forename: Guihua
authors.initials: G
authors.lastname: Chen
authors.affiliation: 1 Clinical Oncology Laboratory, Changzhou Cancer Hospital of Soochow University, Changzhou 213002, China ; 2 The Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200433, China ; 3 The Hepatic Surgery Center, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China ; 4 The Hepatobiliary Surgery Centre, The Ningbo No. 2 Hospital, Ningbo 315010, China.
authors.forename: Tianbao
authors.initials: T
authors.lastname: Zhou
keywords: Pancreatic cancer (PC); diabetes; screening