title: The endoscopist's role in the diagnosis and management of pancreatic cancer.
abstract: Pancreatic cancer remains one of the most lethal malignancies with little improvement in survival over the past several decades in spite of advances in imaging, risk factor identification, surgical technique and chemotherapy. This disappointing outcome is mainly due to failures to make an early diagnosis. In fact, the majority of the patients present with inoperable advanced stages of the disease. Though some of the new tumor markers are promising, we are still in search of the one that has a high sensitivity and accuracy, yet is inexpensive and easy to obtain. The paradigm of management has shifted from up-front surgery followed by adjuvant chemotherapy to neoadjuvant chemoradiation followed by surgery, especially for borderline resectable cancers and even for some resectable cancers. In this article, we will critically assess the limitations of tumor markers and review the advancements in endoscopic techniques in the management of pancreatic cancer.
authors.affiliation: a Department of Gastroenterology, Hepatology, and Nutrition , MD Anderson Cancer Center , Houston , TX , USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
authors.affiliation: b Division of Digestive Diseases, Department of Medicine , Emory University School of Medicine , Atlanta , GA , USA.
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Cassani
authors.affiliation: c Department of Radiology , MD Anderson Cancer Center , Houston , TX , USA.
authors.forename: Priya
authors.initials: P
authors.lastname: Bhosale
authors.affiliation: a Department of Gastroenterology, Hepatology, and Nutrition , MD Anderson Cancer Center , Houston , TX , USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Ross
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003952:Diagnostic Imaging / Q000379:methods*; D004322:Drainage; D055088:Early Detection of Cancer / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D015607:Stents; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: Pancreatic cancer; endoscopic ultrasound-guided FNA; neoadjuvant chemoradiation; radiofrequency ablation; self-expanding metal stent; tumor markers