Cocca S, Pontillo G, Lupo M, Lieto R, Marocchi M, Marsico M, Dell'Aquila E, Mangiafico S, Grande G, Conigliaro R, Bertani H. Pancreatic cancer: Future challenges and new perspectives for an early diagnosis. World J Clin Oncol 2025; 16(2): 97248 [DOI: 10.5306/wjco.v16.i2.97248]
Corresponding Author of This Article
Giuseppina Pontillo, MD, Doctor, Gastroenterology and Endoscopy Unit, Presidio Ospedaliero San Giuseppe Moscati (Aversa, CE) – ASL Caserta, Via Antonio Gramsci, 1, 81031, Caserta 81100, Italy. giu.pontillo@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Silvia Cocca, Marinella Lupo, Margherita Marocchi, Maria Marsico, Giuseppe Grande, Rita Conigliaro, Helga Bertani, Gastroenterology and Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41121, Italy
Giuseppina Pontillo, Gastroenterology and Endoscopy Unit, Presidio Ospedaliero San Giuseppe Moscati (Aversa, CE) – ASL Caserta, Caserta 81100, Italy
Raffaele Lieto, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples 80131, Campania, Italy
Emanuela Dell'Aquila, Department of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome 0144, Italy
Santi Mangiafico, Gastroenterology and Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico “G Rodolico – San Marco”, Catania 95123, Sicilia, Italy
Author contributions: Cocca S, Pontillo G and Lupo M contributed to conceptualization and writing - original draft; Santi M, Lupo M, Marsico M, Marocchi M and Dell’Aquila E contributed to writing - review & editing; Conigliaro LR contributed to reviewing & editing and supervision; Lieto R and Grande G contributed to data curation and formal analysis; Marsico M, Marocchi M, Lupo M and Dell’Aquila E contributed to resources; Bertani H contributed to supervision and conceptualization.
Conflict-of-interest statement: All the authors report no relevant conflicts 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giuseppina Pontillo, MD, Doctor, Gastroenterology and Endoscopy Unit, Presidio Ospedaliero San Giuseppe Moscati (Aversa, CE) – ASL Caserta, Via Antonio Gramsci, 1, 81031, Caserta 81100, Italy. giu.pontillo@gmail.com
Received: May 29, 2024 Revised: September 27, 2024 Accepted: October 21, 2024 Published online: February 24, 2025 Processing time: 196 Days and 5.7 Hours
Abstract
This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis. Currently, pancreatic cancer still has a poor prognosis, mainly due to late diagnosis in an advanced stage. Two main precancerous routes have been identified as pathways to pancreatic adenocarcinoma: The first encompasses a large group of mucinous cystic lesions: intraductal papillary mucinous neoplasm and mucinous cystic neoplasm, and the second is pancreatic intraepithelial neoplasia. In the last decade the focus of research has been to identify high-risk patients, using advanced imaging techniques (magnetic resonance cholangiopancreatography or endoscopic ultrasonography) which could be helpful in finding “indirect signs” of early stage pancreatic lesions. Nevertheless, the survival rate still remains poor, and alternative screening methods are under investigation. Endoscopic retrograde cholangiopancreatography followed by serial pancreatic juice aspiration cytology could be a promising tool for identifying precursor lesions such as intraductal papillary mucinous neoplasm, but confirming data are still needed to validate its role. Probably a combination of cross-sectional imaging, endoscopic techniques (old and new ones) and genetic and biological biomarkers (also in pancreatic juice) could be the best solution to reach an early diagnosis. Biomarkers could help to predict and follow the progression of early pancreatic lesions. However, further studies are needed to validate their diagnostic reliability and to establish diagnostic algorithms to improve prognosis and survival in patients with pancreatic cancer.
Core Tip: Early diagnosis of pancreatic cancer or identification of its precursors can improve the prognosis of this disease, although the detection of early-stage pancreatic cancer or pre-cancerous lesions is still difficult. The current challenge is to find an effective screening system for diagnosis in “high risk” patients (elderly, hereditary syndromes, mutations, etc.). In addition to conventional imaging, endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography play a pivotal role, as well as future application of genetic and biological biomarkers in this setting.
