Evidence Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2021; 27(23): 3148-3157
Published online Jun 21, 2021. doi: 10.3748/wjg.v27.i23.3148
Pancreatitis and pancreatic cancer: A case of the chicken or the egg
Devica S Umans, Sanne A Hoogenboom, Noor J Sissingh, Selma J Lekkerkerker, Robert C Verdonk, Jeanin E van Hooft
Devica S Umans, Sanne A Hoogenboom, Selma J Lekkerkerker, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam 1105 AZ, The Netherlands
Devica S Umans, Noor J Sissingh, Department of Research and Development, St. Antonius Hospital, Nieuwegein 3430 EM, The Netherlands
Noor J Sissingh, Jeanin E van Hooft, Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
Robert C Verdonk, Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein 3430 EM, The Netherlands
Author contributions: Umans DS, Hoogenboom SA and Sissingh NJ wrote the initial draft of the manuscript; Lekkerkerker SJ, Verdonk RC and van Hooft JE critically assessed and edited the manuscript; Umans DS coordinated the writing process and revised the manuscript; Umans DS and Verdonk RC provided the images; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors have nothing to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Devica S Umans, BSc, Research Associate, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands. d.s.umans@amsterdamumc.nl
Received: January 25, 2021
Peer-review started: January 25, 2021
First decision: February 27, 2021
Revised: March 13, 2021
Accepted: May 8, 2021
Article in press: May 8, 2021
Published online: June 21, 2021
Abstract

Acute pancreatitis (AP), chronic pancreatitis (CP) and pancreatic cancer are three distinct pancreatic diseases with different prognoses and treatment options. However, it may be difficult to differentiate between benign and malignant disease. AP may be a first symptom of pancreatic cancer, particularly in patients between the ages of 56 and 75 with presumed idiopathic AP who had a concomitant diagnosis of new-onset diabetes mellitus or patients who present with CP at diagnosis of AP. In these patients, additional imaging is warranted, preferably by endoscopic ultrasonography. CP may lead to pancreatic cancer through oncogenic mutations, mostly in patients with hereditary CP, and in patients in whom risk factors for pancreatic cancer (e.g., nicotine and alcohol abuse) are also present. Patients with PRSS1-mediated CP and patients with a history of autosomal dominant hereditary CP without known genetic mutations may be considered for surveillance for pancreatic cancer. Pancreatic inflammation may mimic pancreatic cancer by appearing as a focal mass-forming lesion on imaging. Differentiation between the above mentioned benign and malignant disease may be facilitated by specific features like the duct-penetrating sign and the duct-to-parenchyma ratio. Research efforts are aimed towards developing a superior discriminant between pancreatitis and pancreatic cancer in the form of imaging modalities or biomarkers. This may aid clinicians in timely diagnosing pancreatic cancer in a potentially curable stage.

Keywords: Pancreatic diseases, Pancreatic neoplasms, Pancreatitis, Pancreas, Chronic Pancreatitis, Exocrine pancreatic

Core Tip: It is essential to distinguish acute pancreatitis and chronic pancreatitis (CP) from pancreatic ductal adenocarcinoma (PDAC), as these diseases have different treatment options and prognoses. Idiopathic acute pancreatitis may be a first symptom of PDAC, and endoscopic ultrasonography should therefore be considered. CP may obscure PDAC, and long-standing inflammation may cause PDAC, especially in hereditary CP and patients with a history of nicotine and alcohol abuse. Patients should be counselled in cessation of tobacco and alcohol use. Pancreatitis may mimic PDAC by presenting as a mass on imaging. Specific imaging features can aid in the differentiation between benign and malignant disease.