Pancreatic cancer

Pancreatic cancer remains a devastating diagnosis whose prognosis has remained largely unchanged over the last two decades. Where possible, surgical resection represents the optimal treatment strategy, yet just one-fifth of patients meet the operative criteria. The non-specific nature of presentation coupled with its relative chemoresistance are partly responsible for the poor survival rates. Improvements in understanding the natural history of the disease, more sophisticated imaging techniques and increased use of endoscopic ultrasound, has allowed earlier detection and expeditious management of pancreatic cancer. The use of FOLFIRINOX and gemcitabine nab-paclitaxel regimens has shown improved median survival in patients with widespread metastatic disease. To this end, these regimens have been used with some success in the neoadjuvant setting. Future perspectives include studying the carcinogenesis of pancreatic malignancy and tumour related genetic mutations, which it is hoped will lead to new developments in the management of pancreatic cancer, and in turn improved survival rates.