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Contemporary Management of Pancreatic Cancer from an Internist Perspective

Published:December 11, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.11.009

      Abstract

      Primary care physicians are in a favorable position to curb the growing burden of pancreatic ductal adenocarcinoma. This review aims to provide an overview of pancreatic ductal adenocarcinoma from a primary care perspective, with a specific focus on risk factors, selection of high-risk individuals for screening, patient presentation at the primary-care clinic, and the role of the internist in supportive care. Overall, the internist is an essential member of the multidisciplinary care team with respect to optimizing patients’ quality of life across various stages of the pancreatic cancer.

      Keywords

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      References

        • Siegel RL
        • Miller KD
        • Jemal A
        Cancer statistics, 2020.
        CA Cancer J Clin. 2020; 70: 7-30
        • Rawla P
        • Sunkara T
        • Gaduputi V
        Epidemiology of pancreatic cancer: global trends, etiology and risk factors.
        World J Oncol. 2019; 10: 10-27
        • Li L
        • Gai X
        The association between dietary zinc intake and risk of pancreatic cancer: a meta-analysis.
        Biosci Rep. 2017; 37BSR20170155
        • Tio M
        • Andrici J
        • Cox MR
        • Eslick GD
        Folate intake and the risk of upper gastrointestinal cancers: a systematic review and meta-analysis.
        J Gastroenterol Hepatol. 2014; 29: 250-258
        • Behrens G
        • Jochem C
        • Schmid D
        • Keimling M
        • Ricci C
        • Leitzmann MF
        Physical activity and risk of pancreatic cancer: a systematic review and meta-analysis.
        Eur J Epidemiol. 2015; 30: 279-298
        • Zhang Y
        • Liang M
        • Sun C
        • et al.
        Statin use and risk of pancreatic cancer: an updated meta-analysis of 26 studies.
        Pancreas. 2019; 48: 142-150
        • Wang H
        • Liu Y
        • Tian Q
        • et al.
        Incretin-based therapies and risk of pancreatic cancer in patients with type 2 diabetes: a meta-analysis of randomized controlled trials.
        Diabetes Obes Metab. 2018; 20: 910-920
        • Zhang JJ
        • Jia JP
        • Shao Q
        • Wang YK
        Diabetes mellitus and risk of pancreatic cancer in China: a meta-analysis based on 26 case-control studies.
        Prim Care Diabetes. 2019; 13: 276-282
        • Kirkegård J
        • Mortensen FV
        • Cronin-Fenton D
        Chronic pancreatitis and pancreatic cancer risk: a systematic review and meta-analysis.
        Am J Gastroenterol. 2017; 112: 1366-1372
        • Lu PY
        • Shu L
        • Shen SS
        • Chen XJ
        • Zhang XY
        Dietary patterns and pancreatic cancer risk: a meta-analysis.
        Nutrients. 2017; 9: 38
        • Lugo A
        • Peveri G
        • Bosetti C
        • et al.
        Strong excess risk of pancreatic cancer for low frequency and duration of cigarette smoking: a comprehensive review and meta-analysis.
        Eur J Cancer. 2018; 104: 117-126
        • Alsamarrai A
        • Das SL
        • Windsor JA
        • Petrov MS
        Factors that affect risk for pancreatic disease in the general population: a systematic review and meta-analysis of prospective cohort studies.
        Clin Gastroenterol Hepatol. 2014; 12: 1635-1644
        • Mao QQ
        • Lin YW
        • Chen H
        • et al.
        Dietary fiber intake is inversely associated with risk of pancreatic cancer: a meta-analysis.
        Asia Pac J Clin Nutr. 2017; 26: 89-96
        • Chen J
        • Jiang W
        • Shao L
        • Zhong D
        • Wu Y
        • Cai J
        Association between intake of antioxidants and pancreatic cancer risk: a meta-analysis.
        Int J Food Sci Nutr. 2016; 67: 744-753
        • Larsson SC
        • Wolk A
        Red and processed meat consumption and risk of pancreatic cancer: meta-analysis of prospective studies.
        Br J Cancer. 2012; 106: 603-607
        • Wang J
        • Wang WJ
        • Zhai L
        • Zhang DF
        Association of cholesterol with risk of pancreatic cancer: a meta-analysis.
        World J Gastroenterol. 2015; 21: 3711-3719
        • Liao WC
        • Tu YK
        • Wu MS
        • Lin JT
        • Wang HP
        • Chien KL
        Blood glucose concentration and risk of pancreatic cancer: systematic review and dose-response meta-analysis.
        BMJ. 2015; 350: g7371
        • Grosso G
        • Bella F
        • Godos J
        • et al.
        Possible role of diet in cancer: systematic review and multiple meta-analyses of dietary patterns, lifestyle factors, and cancer risk.
        Nutr Rev. 2017; 75: 405-419
        • Permuth-Wey J
        • Egan KM
        Family history is a significant risk factor for pancreatic cancer: results from a systematic review and meta-analysis.
        Fam Cancer. 2009; 8: 109-117
        • Klein AP
        • Brune KA
        • Petersen GM
        • et al.
        Prospective risk of pancreatic cancer in familial pancreatic cancer kindreds.
        Cancer Res. 2004; 64: 2634-2638
        • McGuigan A
        • Kelly P
        • Turkington RC
        • Jones C
        • Coleman HG
        • McCain RS
        Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes.
        World J Gastroenterol. 2018; 24: 4846-4861
        • Park W
        • Chen J
        • Chou JF
        • et al.
        Genomic methods identify homologous recombination deficiency in pancreas adenocarcinoma and optimize treatment selection.
        Clin Cancer Res. 2020; 26: 3239-3247
        • Brune K
        • Abe T
        • Canto M
        • et al.
        Multifocal neoplastic precursor lesions associated with lobular atrophy of the pancreas in patients having a strong family history of pancreatic cancer.
        Am J Surg Pathol. 2006; 30: 1067-1076
        • Sarkar FH
        • Banerjee S
        • Li Y
        Pancreatic cancer: pathogenesis, prevention and treatment.
        Toxicol Appl Pharmacol. 2007; 224: 326-336
      1. National Cancer Institute, Surveillance, Epidemiology, and End Results Program. Cancer stat facts: pancreatic cancer 2020. Available at: https://seer.cancer.gov/statfacts/html/pancreas.html. Accessed July 23, 2020.

        • Hruban RH
        • Lillemoe KD
        Screening for pancreatic cancer gets a D, but the student is improving.
        JAMA Surg. 2019; 154: 795-797
        • Yu J
        • Blackford AL
        • Dal Molin M
        • Wolfgang CL
        • Goggins M
        Time to progression of pancreatic ductal adenocarcinoma from low-to-high tumour stages.
        Gut. 2015; 64: 1783-1789
        • Stoffel EM
        • McKernin SE
        • Brand R
        • et al.
        Evaluating susceptibility to pancreatic cancer: ASCO provisional clinical opinion.
        J Clin Oncol. 2019; 37: 153-164
        • Goggins M
        • Overbeek KA
        • Brand R
        • et al.
        Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium.
        Gut. 2020; 69: 7-17
        • Canto MI
        • Hruban RH
        • Fishman EK
        • et al.
        Frequent detection of pancreatic lesions in asymptomatic high-risk individuals.
        Gastroenterology. 2012; 142: 796-804
        • Topazian M
        • Enders F
        • Kimmey M
        • et al.
        Interobserver agreement for EUS findings in familial pancreatic-cancer kindreds.
        Gastrointest Endosc. 2007; 66: 62-67
        • Keane MG
        • Horsfall L
        • Rait G
        • Pereira SP
        A case-control study comparing the incidence of early symptoms in pancreatic and biliary tract cancer.
        BMJ Open. 2014; 4e005720
        • Schmidt-Hansen M
        • Berendse S
        • Hamilton W
        Symptoms of pancreatic cancer in primary care: a systematic review.
        Pancreas. 2016; 45: 814-818
        • Stapley S
        • Peters TJ
        • Neal RD
        • Rose PW
        • Walter FM
        • Hamilton W
        The risk of pancreatic cancer in symptomatic patients in primary care: a large case-control study using electronic records.
        Br J Cancer. 2012; 106: 1940-1944
        • Kramer-Marek G
        • Gore J
        • Korc M
        Molecular imaging in pancreatic cancer–a roadmap for therapeutic decisions.
        Cancer Lett. 2013; 341: 132-138
        • Vachiranubhap B
        • Kim YH
        • Balci NC
        • Semelka RC
        Magnetic resonance imaging of adenocarcinoma of the pancreas.
        Top Magn Reson Imaging. 2009; 20: 3-9
        • Choi M
        • Heilbrun LK
        • Venkatramanamoorthy R
        • Lawhorn-Crews JM
        • Zalupski MM
        • Shields AF
        Using 18F-fluorodeoxyglucose positron emission tomography to monitor clinical outcomes in patients treated with neoadjuvant chemo-radiotherapy for locally advanced pancreatic cancer.
        Am J Clin Oncol. 2010; 33: 257-261
        • Yeh R
        • Dercle L
        • Garg I
        • Wang ZJ
        • Hough DM
        • Goenka AH
        The role of 18F-FDG PET/CT and PET/MRI in pancreatic ductal adenocarcinoma.
        Abdom Radiol (NY). 2018; 43: 415-434
        • Dell'Aquila E
        • Fulgenzi CAM
        • Minelli A
        • et al.
        Prognostic and predictive factors in pancreatic cancer.
        Oncotarget. 2020; 11: 924-941
        • Wong JC
        • Raman S
        Surgical resectability of pancreatic adenocarcinoma: CTA.
        Abdom Imaging. 2010; 35: 471-480
        • Lidsky ME
        • Sun Z
        • Nussbaum DP
        • Adam MA
        • Speicher PJ
        • Blazer 3rd, DG
        Going the extra mile: improved survival for pancreatic cancer patients traveling to high-volume centers.
        Ann Surg. 2017; 266: 333-338
        • Bradley A
        • Van Der Meer R
        Upfront surgery versus neoadjuvant therapy for resectable pancreatic cancer: systematic review and Bayesian network meta-analysis.
        Sci Rep. 2019; 9: 4354
        • Neoptolemos JP
        • Palmer DH
        • Ghaneh P
        • et al.
        Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial.
        Lancet. 2017; 389: 1011-1024
        • Conroy T
        • Hammel P
        • Hebbar M
        • et al.
        Unicancer GI PRODIGE 24/CCTG PA.6 trial: a multicenter international randomized phase III trial of adjuvant mFOLFIRINOX versus gemcitabine (gem) in patients with resected pancreatic ductal adenocarcinomas.
        J Clin Oncol. 2018; 36 (LBA4001-LBA)
        • Scholten L
        • Mungroop TH
        • Haijtink SAL
        • et al.
        New-onset diabetes after pancreatoduodenectomy: a systematic review and meta-analysis.
        Surgery. 2018; S0039-6060: 30081-30083
        • Hashimoto H
        • Abe M
        • Tokuyama O
        • et al.
        Olanzapine 5 mg plus standard antiemetic therapy for the prevention of chemotherapy-induced nausea and vomiting (J-FORCE): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial.
        Lancet Oncol. 2020; 21: 242-249
        • Smith EM
        • Pang H
        • Cirrincione C
        • et al.
        Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial.
        JAMA. 2013; 309: 1359-1367
        • Suzuki H
        • Shinohara A
        • Ohno I
        • et al.
        The effect of duloxetine on chemotherapy-induced peripheral neuropathy in advanced pancreatic cancer patients receiving gemcitabine plus nab-paclitaxel treatment.
        J Clin Oncol. 2017; 35: 453
        • Ahn DH
        • Krishna K
        • Blazer M
        A modified regimen of biweekly gemcitabine and nab-paclitaxel in patients with metastatic pancreatic cancer is both tolerable and effective: a retrospective analysis.
        Ther Adv Med Oncol. 2017; 9: 75-82