➤ PCO 3.1 Pancreatic cancer surveillance can be considered for individuals who
are first-degree relatives of individuals with familial pancreatic cancer and/or
individuals with a family history of pancreatic cancer who carry a pathogenic
germline variant in genes associated with predisposition to pancreatic cancer
(Table 1). (Moderate Statement; IC-B/H)
• The potential risks, benefits, uncertainties, and limitations of surveillance for
pancreatic cancer should be discussed in detail with individuals who are being
considered for pancreatic cancer surveillance prior to beginning such surveillance.
• When possible, pancreatic surveillance should be performed at centers with the
appropriate expertise to manage individuals at increased risk for pancreatic cancer.
• Surveillance may be performed with various modalities, including pancreas protocol
MRI/MRCP and/or endoscopic ultrasound.
• There are currently no approved biomarkers for screening and surveillance.
▶ CA 19-9 is not recommended as a screening test in the general population due to
low specificity and sensitivity; its potential utility in pancreatic screening of high
risk individuals has not been established.
Qualifying Statement. Although large studies confirming mortality benefit of pancreatic
screening are lacking, emerging data suggest screening in individuals at high risk is
associated with downstaging of incident cancers.
➤ PCO 3.2 There is not yet consensus on pathologic targets for surveillance, but
the Expert Panel agrees the ultimate goal should be detection and treatment
of high-grade dysplasia to prevent invasive cancer. (Moderate Statement;
IC-B/H)
➤ PCO 3.3 The potential risks of surveillance including the risk of overtreatment,
and unnecessary resections should be discussed with the patient. (Moderate
Statement; IC-B/H)
• Given the challenges, patients should optimally be managed by an expert multi-
disciplinary team with experience in pancreatic cancer surveillance.
• Additional clinical studies are needed to determine the optimal approach for
pancreatic surveillance.
➤ PCO 3.4 There is currently a lack of consensus regarding which lesions
discovered by pancreatic imaging require resection.
• Findings that generally warrant resection include lesions which are solid, and/or
which are associated with obstructive jaundice and/or dilation of the main pancreatic
duct >10mm.
• The presence of "worrisome features" (cyst size >3 cm, thickened/enhancing walls,
mural nodule, dilated main pancreatic duct >5 mm, abrupt change in duct caliber or
rapid growth) and the presence of 3 or more pancreatic cysts in the pancreas of high-
risk individuals is associated with an increased risk of neoplastic progression.
Assessment
