ROLE OF ENDOSCOPY IN THE EARLY DIAGNOSIS OF FAMILIAL PANCREATIC CANCER

Abstract

The risk of pancreatic cancer is increased among individuals with a family history of pancreatic cancer and among patients with several genetic cancer syndromes. In Western countries, since 2000, clinical surveillance in these high-risk groups was initiated for the early detection of pancreatic cancer. In addition to magnetic resonance imaging (MRI) and computed tomography (CT), endoscopic ultrasonography (EUS) has been used because of its high resolution of both the pancreatic duct and pancreatic parenchyma. When a lesion is suspected of being cancer or its precursor, endoscopic retrograde pancreatography (ERP) and EUS-guided fine needle aspiration (EUS-FNA) have been performed for further evaluation and acquisition of pathological samples. Characteristic EUS findings of the pancreas of high-risk individuals with a family history of pancreatic cancer include high echoic foci, high echoic strand, presence of a cyst, high echoic margin of the main pancreatic duct and lobularity, which are also suggestive of early chronic pancreatitis. In 2011, the International Cancer of the Pancreas Screening (CAPS) Consortium was held, and the goal of surveillance was set as diagnosis and treatment of high-grade epithelial lesions (PanIN3)〜 stage 1 pancreatic cancer. However, to date, the status of surveillance is far from the goal set at the Consortium. In 2014, the Japanese Familial Pancreatic Cancer Registry was established and clinical surveillance is about to start in Japan.