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World J Gastroenterol. Dec 28, 2022; 28(48): 6827-6845
Published online Dec 28, 2022. doi: 10.3748/wjg.v28.i48.6827
Clinical diagnosis and management of pancreatic cancer: Markers, molecular mechanisms, and treatment options
Chun-Ye Zhang, Shuai Liu, Ming Yang
Chun-Ye Zhang, Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, United States
Shuai Liu, The First Affiliated Hospital, Zhejiang University, Hangzhou 310006, Zhejiang Province, China
Ming Yang, Department of Surgery, University of Missouri, Columbia, MO 65211, United States
Author contributions: Zhang CY, Liu S, and Yang M designed the review, collected data, and wrote, revised, and finalized the manuscript; All authors contributed equally and shared the first authorship.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to this paper.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming Yang, DVM, PhD, Postdoctoral Fellow, Department of Surgery, University of Missouri, Room 2203, NexGen Precision Building, 1030 Hitt Street, Columbia, MO 65211, United States. yangmin@health.missouri.edu
Received: September 17, 2022
Peer-review started: September 17, 2022
First decision: October 30, 2022
Revised: November 4, 2022
Accepted: November 28, 2022
Article in press: November 28, 2022
Published online: December 28, 2022
Abstract

Pancreatic cancer (PC) is the third-leading cause of cancer deaths. The overall 5-year survival rate of PC is 9%, and this rate for metastatic PC is below 3%. However, the PC-induced death cases will increase about 2-fold by 2060. Many factors such as genetic and environmental factors and metabolic diseases can drive PC development and progression. The most common type of PC in the clinic is pancreatic ductal adenocarcinoma, comprising approximately 90% of PC cases. Multiple pathogenic processes including but not limited to inflammation, fibrosis, angiogenesis, epithelial-mesenchymal transition, and proliferation of cancer stem cells are involved in the initiation and progression of PC. Early diagnosis is essential for curable therapy, for which a combined panel of serum markers is very helpful. Although some mono or combined therapies have been approved by the United States Food and Drug Administration for PC treatment, current therapies have not shown promising outcomes. Fortunately, the development of novel immunotherapies, such as oncolytic viruses-mediated treatments and chimeric antigen receptor-T cells, combined with therapies such as neoadjuvant therapy plus surgery, and advanced delivery systems of immunotherapy will improve therapeutic outcomes and combat drug resistance in PC patients. Herein, the pathogenesis, molecular signaling pathways, diagnostic markers, prognosis, and potential treatments in completed, ongoing, and recruiting clinical trials for PC were reviewed.

Keywords: Pancreatic cancer, Pancreatic ductal adenocarcinoma, Molecular mechanisms, Diagnostic and prognostic markers, Treatment, Clinical trials

Core Tip: Pancreatic cancer (PC) is the third-leading cause of cancer deaths. Pancreatic ductal adenocarcinoma is the most common type of PC in the clinic. Multiple pathogenic processes including inflammation, fibrosis, angiogenesis, epithelial-mesenchymal transition, and proliferation of cancer stem cells are involved in PC initiation and progression. Although some therapies have been approved for PC treatment, the overall 5-year survival rate is still very low. A combined panel of serum markers is very helpful for PC diagnosis. New treatments and more clinical trials are required to search for new potent therapeutic agents and to evaluate their efficacy in PC treatment.