Early Detection of Pancreatic Cancer

Sushil Kumar Garg; Suresh T. Chari

Disclosures

Curr Opin Gastroenterol. 2020;36(5):456-461. 

In This Article

New-onset Diabetes

The relationship between diabetes and pancreatic cancer has been known more than 100 years now;[22] however, the intricate multidirection link between diabetes and pancreatic cancer has not been fully understood. Although long-standing diabetes mellitus patients have a modest increase in risk of developing pancreatic cancer (1.5–2-fold), patients over 50 years with NOD have a six to eight-fold higher risk of having pancreatic cancer and 1% probability of development of pancreatic cancer in 3 years following glycemic onset of diabetes.[23,24] Hyperglycemia in patients with pancreatic cancer is unlikely to be due to pancreatic gland destruction since hyperglycemia starts before the cancer is visible on imaging.[25] NOD appears to be a paraneoplastic phenomenon that precedes the diagnosis of pancreatic cancer.[26]

An epidemiological study done in patients of pancreatic cancer at diagnosis has shown that 42% of patients had diabetes by American Diabetes Association criteria, 13% had advanced prediabetes mellitus [defined as fasting blood glucose (FBG) ≥ 120 mg/dl], 21% have impaired FBG, and only 9% had a normal FBG level. Among patients of pancreatic cancer with NOD, diabetes mellitus resolved in 57% of patients after pancreatic cancer resection.[27] In another study done by Sharma et al.;[28] showed that hyperglycemia was first noted 36–30 months before pancreatic cancer diagnosis and mean FBG keeps rising until the diagnosis of pancreatic cancer. The degree of glycemia was associated with increasing tumor volume and with poor differentiation of tumors.[28] The onset of hyperglycemia about three before the diagnosis of pancreatic cancer provides a unique opportunity for early detection of pancreatic cancer.

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