Release date: 2015-06-11 1. Proportion of patients under 45 years old in patients with pancreatic cancer According to the data from the Monitoring, Epidemiology and Final Results Database (2006-2010), less than 3% of all pancreatic cancer patients in the United States are under 45 years of age. The median age at diagnosis was 71 years. A literature review shows that global pancreatic cancer is more common in elderly patients, with more than 80% of cases over 60 years of age. More importantly, the literature shows that the mortality rate of pancreatic cancer is about 99%. 2. Global cancer mortality rate ranks high in pancreatic cancer Global Cancer Epidemiology Statistics (GLOBOCAN) show that pancreatic cancer is the 13th most common tumor worldwide and ranks 4th among tumor-related deaths in Western countries. Other tumors such as prostate cancer, colorectal cancer, lung cancer, despite suffering The disease rate is high, but the mortality rate is lower than that of pancreatic cancer. About 99% of patients with pancreatic cancer are currently dying. 3. Pancreatic cancer without early warning signs Pancreatic cancer is difficult to diagnose. According to the National Comprehensive Cancer Network (NCCN), there is no clear early warning signs of pancreatic cancer [10], and the pancreatic cancer screening process is lacking, and the disease diagnosis is often in the advanced stage. Studies have shown that the symptoms of patients with pancreatic cancer are not specific and can be confused with other unrelated diseases, and usually only when the disease has spread locally or distantly. The investigators estimated that approximately 85% of patients had local or distant metastases at the time of diagnosis. 4. CA 19-9 is currently the most commonly used serum marker for pancreatic cancer, but has limited value in diagnostic applications. As the most commonly used serum marker in clinical practice, CA 19-9 has limited application value in the diagnosis of pancreatic cancer because of its lack of specificity. Studies have shown that their positive predictive value as a screening marker is low (0.5%-0.9%), and therefore lacks application value as a screening marker. However, CA 19-9 levels are still clinically tested as a baseline to monitor disease progression and guide treatment. For example, the NCCN guidelines recommend testing CA 19-9 levels prior to surgery (normal bilirubin levels) and adjuvant therapy for monitoring. 5. Due to the clinical manifestations of pancreatic cancer, the median survival depends on the tumor site. The clinical manifestations of pancreatic cancer often depend on the location of the tumor in the pancreas. Most of the initial symptoms are unclear and lack specificity. In addition, the location of the tumor in the pancreas may be related to survival. This correlation is independent of other clinical factors, such as the degree of metastasis. Certain symptoms, especially jaundice, are associated with cancer of the head of the pancreas and suggest a relatively good prognosis. Jaundice occurs generally earlier than other symptoms of pancreatic cancer, such as back pain and fatigue. The median survival time of patients with pancreatic cancer or pancreatic cancer was significantly shorter than that of patients with pancreatic head cancer (4 months vs 6 months, P < 0.001) [15], which may be due to the lack of clear symptoms of pancreatic cancer or pancreatic cancer. , causing a delay in diagnosis. Even in patients who have undergone surgical resection and no metastasis, the survival of patients with pancreatic cancer or pancreatic cancer is still lower than that of patients with pancreatic cancer. 6. A variety of factors affect the development of precancerous lesions of pancreatic cancer Non-invasive precancerous lesions can progress to pancreatic adenocarcinoma. The researchers speculate that these precancerous lesions may be caused by a variety of genetic mutations. The most common genetic mutations include: â— KRAS oncogene mutation activation (discovered in approximately 90% of patients) â— Inhibition of tumor suppressor genes CDKN2A, TP53, SMAD4 and BRCA29 â— The hedgehog signaling pathway is dysregulated, especially in conjunction with KRAS mutations. â— Loss of p16 function, leading to cell division cycle regulation disorder â— Notch2 expression, a key regulatory molecule in the progression of intraepithelial neoplasia â— Extensive chromosome loss and gene amplification â— Telomere shortening 7. No suitable means have been found for early pancreatic cancer screening A literature review indicates that further exploration is needed to establish an effective early pancreatic cancer screening tool. Currently, many international research projects attempt to use standardized screening methods in their research. These studies used ultrasound endoscopy as the primary imaging method to identify precancerous lesions. In addition, these research centers also screen for mutations in markers such as KRAS, MIC-1, p53 and p16. However, the sensitivity and specificity of these markers have not met the requirements of clinical routine applications. 8. The survival of advanced metastatic pancreatic cancer depends on the degree of disease progression at the time of diagnosis. The survival time of patients with advanced, metastatic pancreatic cancer depends largely on the degree of disease progression at the time of diagnosis. An analysis of the US cancer patient database showed that the median survival of early patients undergoing pancreatic resection was around 19 months. Another study showed that patients with locally advanced pancreatic cancer had a survival period of 9-15 months, and patients with distant metastases had a survival period of 3-6 months. 9. Determining whether surgical resection of pancreatic cancer is essential for clinical staging "From a clinical practice perspective, pancreatic cancer is classified into resectable, local progression, and metastatic pancreatic cancer. Although different pancreatic cancer experts may have some differences in patient classification, treatment options and prognosis are based on this classification. Because surgical resection is the only possible cure, surgery can be the most important factor in clinical staging." 10. Progress in imaging promotes diagnosis of pancreatic cancer Tomography PET: Until recently, PET was limited in its application to pancreatic cancer. The emergence of a new F-18-labeled fluorodeoxyglucose PET scan (FDG-PET) has changed this. One study showed that FDG-PET can distinguish between tumors and benign masses, such as those associated with pancreatitis, with an accuracy of approximately 90%. But its high price, special equipment and professional requirements limit its application. PET is also associated with CT to improve the accuracy of tumor anatomy and functional localization. Laparoscopic staging: A growing body of research evidence supports the selective application of laparoscopic staging in the following situations: â— Tumor located in the neck, pancreas or pancreas of the pancreas â— Suspected primary tumor with a diameter of 3 cm or more â— Imaging suggests the possibility of distant transfer The NCCN guidelines mention that when clinical patients have other clinical factors, such as elevated CA 19-9, laparoscopic staging may also be required. Expert consensus differs on the value of laparoscopic staging applications. Supporters believe that laparoscopic efficiency is high and well tolerated. Opponents believe that high-quality imaging studies in most patients can achieve the same results as laparoscopy. However, both parties believe that ineffective laparoscopic applications should be avoided to ensure the comfort and quality of life of patients in advanced stages. 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