Detection of Pancreatic Cancer and Nutritional Support in Chronic Pancreatitis

Abstract

Chronic pancreatitis (CP) is a significant risk factor for pancreatic cancer and there had been a great deal of interest in surveillance and detection of pancreatic cancer. According to presence of genetic mutation, CP can be classified into hereditary CP and sporadic CP. CP with PRSS1 gene mutation showed a high incidence of pancreatic cancer justifying screening and surveillance for those older than 40 years. But CP with other mutations and sporadic CP have relatively low incidence of pancreatic cancer and surveillance is not recommended. While computed tomography or magnetic resonance imaging is widely used for screening, endoscopic ultrasound is not recommended because of parenchymal inflammation, fibrosis, and calcification associated with CP. However, when a patient with CP has multiple risk factors for pancreatic cancer, risk of pancreatic cancer increases significantly. Patients with CP have increased risk of pancreatic cancer at five years after diagnosis; individualized screening and surveillance based on symptoms and specific circumstances should be considered. Patients with CP have a high risk of malnutrition and malnutrition is quite common. Clinicians should assess nutritional status and implement nutritional support. Nutritional support must include both macronutrients and micronutrients. Given the high risk of osteoporosis and osteopathy in CP, clinicians should consider early diagnosis, prevention, and treatment. Consultation with nutritional support team is highly recommended.