Pancreatic cancer

Malignant tumors of the pancreas—mainly pancreatic ductal adenocarcinoma (PDAC)—display a significant cancer burden to the population with an incidence of ~12.1/100,000 and a mortality of ~11.1/100,000 (1). In the Western world and in Germany, PDAC is currently ranked fourth place for causing cancer-related deaths (1,2). Furthermore, due to the increasing prevalence of PDAC and the stagnation in treatment strategies, PDAC is expected to reach rank two of cancer-related deaths by the year of 2030 (2).

For diagnosis of pancreatic cancer modern imaging techniques as wells as endosonography and FNA are essential, to accurately assess tumor burden and plan therapy accordingly. Especially in advanced stages of pancreatic cancer or borderline resectable tumors neoadjuvant chemotherapy/radiochemotherapy is applied to increase rates of secondary resectability and to improve outcome of the patient (3,4). In such advanced stages, also radical resections are warranted which may also include vessel resections (e.g., portal vein/superior mesenteric vein) (3). In resectable tumors adjuvant chemotherapy is recommended after resection of the primary tumor (3,5).

For patients with palliative situations (e.g., distant metastases) palliative chemotherapy as wells as in selected patients palliative surgery can be combined with palliative application of RFA, IRE or application of stents to attenuate patients’ symptoms (3,6). Furthermore, adequate nutritionals concepts in conjunction with pancreatic enzyme replacement therapy play a pivotal role in patients with pancreatic cancer, independent on the tumor stage.

All these aspects are addressed in this focused issue on pancreatic cancer and for each topic an expert and his coworkers of the field contributed an up-to-date-review on current clinical practice and the latest literature covering the field. We hope that this special issue will serve as a helpful guide for clinicians dealing with pancreatic cancer patients. We hope it will contribute to the decision-making processes in the clinic and give inspiration for novel well designed clinical studies to improve the diagnostic and treatment options for pancreatic cancer patients.

Acknowledgments

None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

References

1. Koch-Institut, Z.f.K.i.R. 2018. Available online: https://www.krebsdaten.de/Krebs/SiteGlobals/Forms/Datenbankabfrage/datenbankabfrage_stufe2_form.html
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;69:7-34. [Crossref] [PubMed]
3. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, D.K., K. AWMF): S3-Leitlinie Exokrines Pankreaskarzinom, 2013 AWMF, and h.l.d.L.h. Registernummer: 032-010OL. Available online: https://www.awmf.org/leitlinien/detail/ll/032-010OL.html
4. Hackert T, Sachsenmaier M, Hinz U, et al. Locally Advanced Pancreatic Cancer: Neoadjuvant Therapy With Folfirinox Results in Resectability in 60% of the Patients. Ann Surg 2016;264:457-63. [Crossref] [PubMed]
5. Neoptolemos JP, Palmer DH, Ghaneh P, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet 2017;389:1011-24. [Crossref] [PubMed]
6. Scheufele F, Friess H. Palliative Surgery in Advanced Pancreatic Cancer. Available online: https://www.researchgate.net/publication/318176718_Palliative_Surgery_in_Advanced_Pancreatic_Cancer

Univ.-Prof. Dr. Helmut Friess

Dr. Florian Scheufele