Pancreatic Ductal Adenocarcinoma
A special issue of Cancers (ISSN 2072-6694).
Deadline for manuscript submissions: closed (30 April 2020) | Viewed by 38855
Special Issue Editors
Interests: liver surgery; liver transplantation; hepatocellular carcinoma; liver metastases; cholangiocarcinoma; pancreatic surgery; pancreatic ductal adenocarcinoma; ultrasonography; statistical analysis
Interests: pancreatic ductal adenocarcinoma; pancreatic neuroendocrine tumors; pancreatic cystic neoplasms; intraductal papillary mucinous neoplasm; HPB surgery
Special Issue Information
Dear Colleagues,
Exocrine pancreatic cancer brings a particularly poor prognosis, and by 2030, it will probably become the second cause of cancer-related death in developed countries. Surgery remains the only potentially curative treatment, but due to the late presentation, only a minority of patients are candidates for pancreatectomy.
Most ductal adenocarcinomas are generally considered to arise from PanIN, developing as a result of a series of genetic events. Moreover, research on hereditary risk factors for pancreatic cancer (hereditary breast ovarian cancer syndrome, lynch syndrome, Peutz–Jeghers syndrome, familial pancreatic cancer, hereditary pancreatitis) has helped us to understand some of its specific molecular basis. Currently, we know that pancreatic cancer is a genetic disease that is caused by inherited and acquired mutations in specific cancer-associated genes. The main key signaling pathways dysregulated in pancreatic tumorigenesis are now understood (KRAS, TP53, p16/CDKN2A, SMAD4, MLH1, MSH2). Particularly important is the role of the KRAS oncogene, an early mutation occurring in more than 90% of pancreatic cancers. This gene can be one reliable biomarker that molecular genetics might offer to clinicians for early detection (as well as microRNAs). Furthermore, the SMAD4 gene status could also become a useful tool for prognostic stratification and therapeutic decision making. Indeed, the recognition of germline mutations in pancreatic cancer genes implies the possibility of genetic testing in order to provide clinical benefits to the patients. In addition, one of the main present challenges in this field is to identify cancer susceptibility mutations that might be therapeutically targetable (oxaliplatin in BRCA mutations or nab-paclitaxel in presence of SPARC overexpression). In the next few decades, it will be important to create an algorithm that includes biological and molecular therapies, as already happens for colorectal or breast cancer. The improvement in chemotherapeutic regimens will lead to new clinical possibilities such as considering combined resections of primary pancreatic cancer and liver metastases in highly selected patients. However, predictors of outcome are not yet identified; similarly, the oncological advantage of such procedures is still under debate and requires further investigations.
This Special Issue will highlight the role of molecular genetics in pancreatic cancer and its possible implications in early diagnosis as well as development of future target therapies. It will also focus on the growing feeling of a potential benefit of extended surgery in identified patients with oligometastatic pancreatic cancer, trying to fill the lack of evidence.
Dr. Alessandro Cucchetti
Dr. Carlo Alberto Pacilio
Guest Editors
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Keywords
- Pancreatic ductal adenocarcinoma
- Pancreatic intraepithelial neoplasia
- Familial pancreatic cancer
- KRAS
- SMAD4
- MicroRNAs
- Targeted therapy
- Neoadjuvant therapies
- Liver metastasis
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