Pancreatic intraepithelial neoplasia - can we detect early pancreatic cancer?

Beate Haugk (1)

1 Cellular Pathology

Pancreatic cancer is one of the most lethal cancers with an incidence equalling mortality. Pancreatic cancer is a heterogeneous group in which pancreatic ductal adenocarcinoma (PDAC) is the commonest. It is now established that PDAC develops through stepwise progression from precursor lesions. Detection and treatment of these precursor lesions would allow curative treatment. Three precursor lesions for PDAC have been identified. Two of these - mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs) - are rare, radiologically detectable, cystic precursor lesions which can be cured if treated at the pre-invasive stage. The third and commonest precursor lesion has recently been defined as pancreatic intraepithelial neoplasia (PanIN). PanINs are microscopic lesions with no clinical correlate. They display a spectrum of cyto-architectural changes (PanIN-1, PanIN-2 and PanIN-3) mirrored in an increasing accumulation of molecular genetic changes with PanIN-3 sharing many of the alterations with PDAC. The great advances in the understanding of pancreatic carcinogenesis have opened avenues for diagnosis and chemoprevention. However, access to the pancreas is limited, molecular tests are at the early stages and too little is known about the natural history of early PanINs to justify resection. Currently screening focuses on high risk individuals only.

Mots clés: Medicine

Beate Haugk. Pancreatic intraepithelial neoplasia - can we detect early pancreatic cancer?. Histopathology, 2010, 57 (4), pp.503. ⟨10.1111/j.1365-2559.2010.03610.x⟩. ⟨hal-00580346⟩