Screening for pancreatic adenocarcinoma
When is this exam indicated?
An estimated 5 to 15% of pancreatic adenocarcinomas arise on a hereditary/genetic basis. Some known genetic mutations are associated with increased cancer risk.
These mutations are for example those linked to genetically based chronic pancreatitis (SPINK1, PRSS1, CFTR, CTRC), mutations in Familial Melanoma Syndrome (CDKN2A), Peutz-Jeghers Syndrome (STK11/LKB1) or mutations in genes linked to breast and ovarian cancer (BRCA1/BRCA2), PALB2 or Lynch Syndrome (MSH2, MLH1).
However, there are many cases of families with multiple cases of pancreatic cancer (at least two cases on the same branch, maternal or paternal) in which there are no mutations of this kind (or in which there are mutations not identified to date) and in this case we speak of "Familial Pancreatic Cancer" (FPC).
These subjects, on the basis of their age and that of the family member(s) affected by pancreatic cancer, have the indication to be monitored within the ITALIAN REGISTER OF FAMILIES AT RISK OF PANCREAS CANCER (IRFARPC) of the Italian Association for the Study of Pancreas (AISP), of which the Pancreas Center of Ospedale San Raffaele is one of the promoters.
How is it performed?
The IRFARPC registry provides for the execution of a Nuclear Magnetic Resonance of the upper abdomen with contrast medium and Cholangio-Resonance Magnetic Resonance sequences or an Echocardioscopy of the pancreas, generally once a year (or more frequently, if alterations worthy of close monitoring are detected), generally alternating the methods.
These "imaging" examinations evaluate the pancreatic gland, looking for possible alterations of the pancreas (such as cysts or small solid lesions) and therefore possible precursors of pancreatic cancer, in order to treat the patient early, before the onset of an invasive and advanced tumor.