Multi-step pancreatic carcinogenesis and its clinical implications

The poor prognosis of pancreatic cancer relates mainly to its delayed diagn osis. It has been repeatedly shown that earlier diagnosis of pancreatic can cer is associated with a better outcome. Molecular diagnostic methods (main ly detection of K-ms mutations in pure pancreatic or duodenal juice, on spe cimens obtained by percutaneous fine-needle aspirations or in stool specime ns) can achieve earlier diagnosis in selected subgroups of patients, such a s patients,vith chronic pancreatitis (especially hereditary), adults with r ecent onset of non-insulin-dependent diabetes mellitus and patients with so me inherited disorders that predispose to the development of pancreatic can cer. There is increasing evidence that pancreatic carcinogenesis is a multi -step phenomenon, Screening procedures for precursor lesions in these selec ted subgroups of patients may reduce the incidence and mortality from pancr eatic cancer.