Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2021; 13(6): 472-494
Published online Jun 15, 2021. doi: 10.4251/wjgo.v13.i6.472
Current controversies and advances in the management of pancreatic adenocarcinoma
Muhammad Shehroz Zeeshan, Zeeshan Ramzan
Muhammad Shehroz Zeeshan, Zeeshan Ramzan, Gastrointestinal Section, Department of Medicine, Texas Health Harris Methodist Hospital, Fort Worth, TX 76104, United States
Author contributions: Zeeshan MS was responsible for collecting reference articles, manuscript writing and figure/table generation; Ramzan Z provided expertise in the field of gastrointestinal endoscopy, manuscript writing and editing, and designing the aims of the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interest for this article.
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:
Corresponding author: Zeeshan Ramzan, AGAF, FACG, Associate Professor, Gastrointestinal Section, Department of Medicine, Texas Health Harris Methodist Hospital, 1301 Pennsylvania Ave, Fort Worth, TX 76104, United States.
Received: January 8, 2021
Peer-review started: January 8, 2021
First decision: February 24, 2021
Revised: March 22, 2021
Accepted: May 25, 2021
Article in press: May 25, 2021
Published online: June 15, 2021

Pancreatic adenocarcinoma is a lethal disease with a mortality rate that has not significantly improved over decades. This is likely due to several challenges unique to pancreatic cancer. Most patients with pancreatic cancer are diagnosed at a late stage of disease due to the lack of specific symptoms prompting an early investigation. A small subset of patients who are diagnosed at an early stage have a better chance at survival with curative surgical resection, but most patients still succumb to the disease in a few years. The dismal overall prognosis is due to suspected micro-metastasis at an early stage. Due to this reason, there is a recent interest in treating all patients with pancreatic cancers with systemic therapy upfront (including the ones that are surgically resectable). This approach is still not the standard of care due to the lack of robust prospective data available. Recent advancements in treatment regimens of chemotherapy, radiation and immunotherapy have improved the overall short-term survival but the long-term survival still remains poor. Novel approaches in diagnosis and treatment have shown promise in clinical studies but long-term clinical data is lacking. The following manuscript presents an overview of the epidemiology, diagnosis, staging, recent advances, novel approaches and controversies in the management of pancreatic adenocarcinoma.

Keywords: Pancreatic adenocarcinoma, Advances in management, Imaging, Novel approaches, Chemotherapy, Controversies

Core Tip: Early diagnosis and treatment of pancreatic adenocarcinoma has remained a challenge over the last several decades. Despite best efforts, the long-term survival rate has not significantly improved. The following manuscript highlights the current advances and controversies in the management of pancreatic cancer. The standard systemic therapies have been presented in a format that is easy to read and follow. Novel approaches in diagnosis and management have been discussed in light of evidence-based medicine.