There is a malignant tumor whose mortality rate can reflect the incidence rate in the world, and that is pancreatic cancer. The incidence of pancreatic cancer is equal to the mortality rate. There are about 200,000 new cases of pancreatic cancer every year in the world, accounting for 2% of all malignant tumors. At the same time, the annual death toll of pancreatic cancer is about 196,000.
Thus, pancreatic cancer mortality reflects pancreatic cancer prevalence rate. With the improvement of living standards, the incidence of pancreatic cancer has gradually increased, accounting for the ninth place in the incidence of tumors in my country, and the sixth place in the death rate.
Pancreatic cancer is relatively hidden, It is difficult to detect early, which is one of the reasons for the poor prognosis of pancreatic cancer patients. When they are discovered, they are all in the middle and late stage, and they cannot be cured by surgery, which will inevitably lead to the rapid deterioration of the patient’s condition in the later stage. Even so, the incidence of pancreatic cancer still has a specific population, and there are four types of population that belong to the high-risk population of pancreatic cancer.
Individuals at high risk of hereditary pancreatic cancer
Individuals at high risk of hereditary pancreatic cancer refer to individuals with a family history of pancreatic cancer or confirmed carriers of pancreatic cancer Individuals with susceptibility genes. A family history of pancreatic cancer is considered to be present if at least two members of a family who are mutual first-degree relatives are diagnosed with pancreatic cancer. In individuals with a family history of pancreatic cancer, the risk of developing pancreatic cancer is directly related to the number of first-degree relatives with pancreatic cancer.
For example, if there is a first-degree relative with pancreatic cancer , the individual’s cancer risk is 4-6 times that of the general population, and when the number of first-degree relatives with cancer reaches 3, the individual’s cancer risk increases to 17-32 times that of the general population. There is a family history of pancreatic cancer, and the initial screening age is 50 years old, or 10 years earlier than the youngest pancreatic cancer patient in the family.
Pancreatic cancer susceptibility genes include STK11 gene, CDKN2A gene For patients with STK11 gene mutation carriers belonging to Peutz-Jeghers syndrome, the guidelines recommend (evidence quality: A, recommendation strength: strong) for early screening of pancreatic cancer for the above two gene mutation carriers. The starting age for screening is 40 years.
In addition, BRCA1, BRCA2, PALB2, ataxia mutant protein (ATM), MLH1 , MSH2, MSH6 or APC gene mutation carriers, and at least one affected first-degree relative, early screening for pancreatic cancer is recommended. (Quality of evidence: B, Strength of recommendation: strong)
< span>Chronic pancreatitis
Patients with chronic pancreatitis belong to the high-risk group of pancreatic cancer.Guidelines recommend early screening for pancreatic cancer in patients with chronic pancreatitis. Patients with chronic pancreatitis carrying PRSS1 mutations have a significantly higher risk of cancer than other patients with chronic pancreatitis. Therefore, gene mutation detection, especially PRSS1 mutation detection, is recommended for patients with chronic pancreatitis of unknown etiology. The starting age for screening is 40 years.
New onset diabetes< /span>
50+ and Low body mass index and/or unexplained weight loss and short-term glycemic fluctuationsEarly screening for pancreatic cancer is recommended for large new-onset diabetic patients. If you are a high-risk individual with hereditary pancreatic cancer, you should be screened for pancreatic cancer in time when you develop diabetes.
Pancreatic cystic neoplasm
Guidelines recommend for patients with pancreatic cystic tumors at high risk of cancer, including mucinous cysts Early screening of pancreatic cancer can be performed for malignant neoplasm (MCN), solid pseudopapillary neoplasm (SPN), cystic neuroendocrine tumor (cNET), and intraductal papillary mucinous neoplasm of the pancreas (IPMN). For the above lesions, elective surgery can be performed under multidisciplinary discussion.
Pancreatic cancer early screening project:
Initial detection uses fasting blood glucose and/or glycosylated hemoglobin A1c+serum CA19-9 combined with MRI, EUS or CT detection. If there is no abnormality, recheck every 12 months, and regularly check fasting blood glucose and/or HbA1c+serum CA19-9 during follow-up, and use MRI, EUS or CT testing alternately.
If pancreatic solid lesions or pancreatic cystic tumors with warning signs are found during follow-up, it is recommended to use endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) to clarify the pathology.