Review
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World J Gastroenterol. Feb 21, 2011; 17(7): 867-897
Published online Feb 21, 2011. doi: 10.3748/wjg.v17.i7.867
Advances in diagnosis, treatment and palliation of pancreatic carcinoma: 1990-2010
Chakshu Sharma, Karim M Eltawil, Paul D Renfrew, Mark J Walsh, Michele Molinari
Chakshu Sharma, Karim M Eltawil, Paul D Renfrew, Mark J Walsh, Michele Molinari, Department of Surgery, Queen Elizabeth ІІ Health Sciences Center, Dalhousie University, Halifax, Nova Scotia, B3H 2Y9, Canada
Author contributions: Sharma C, Eltawil KM and Molinari M contributed equally to this work; Sharma C performed the systematic literature review, contributed to the appraisal of the literature and wrote the paper; Eltawil KM performed the systematic literature review, contributed to the appraisal of the literature and wrote the paper; Renfrew PD and Walsh MJ contributed to the design framework of the systematic review; Molinari M performed the systematic literature review, contributed to the appraisal of the literature and wrote the paper.
Correspondence to: Michele Molinari, MD, Department of Surgery, Queen Elizabeth ІІ Health Sciences Center, Dalhousie University, Rm 6-254, Victoria Building, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada. michele.molinari@cdha.nshealth.ca
Telephone: +1-902-4737624 Fax: +1-902-4737639
Received: October 25, 2010
Revised: December 8, 2010
Accepted: December 15, 2010
Published online: February 21, 2011
Abstract

Several advances in genetics, diagnosis and palliation of pancreatic cancer (PC) have occurred in the last decades. A multidisciplinary approach to this disease is therefore recommended. PC is relatively common as it is the fourth leading cause of cancer related mortality. Most patients present with obstructive jaundice, epigastric or back pain, weight loss and anorexia. Despite improvements in diagnostic modalities, the majority of cases are still detected in advanced stages. The only curative treatment for PC remains surgical resection. No more than 20% of patients are candidates for surgery at the time of diagnosis and survival remains quite poor as adjuvant therapies are not very effective. A small percentage of patients with borderline non-resectable PC might benefit from neo-adjuvant chemoradiation therapy enabling them to undergo resection; however, randomized controlled studies are needed to prove the benefits of this strategy. Patients with unresectable PC benefit from palliative interventions such as biliary decompression and celiac plexus block. Further clinical trials to evaluate new chemo and radiation protocols as well as identification of genetic markers for PC are needed to improve the overall survival of patients affected by PC, as the current overall 5-year survival rate of patients affected by PC is still less than 5%. The aim of this article is to review the most recent high quality literature on this topic.

Keywords: Diagnosis; Epidemiology; Palliation; Pancreatic cancer; Therapy