Managing patients with increased risk for familial pancreatic cancer


  • Dawn O'Shea
  • Univadis Medical News
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Updated guidance on surveillance of patients with an increased risk for familial pancreatic cancer from the International Cancer of the Pancreas Surveillance (CAPS) Consortium.

Key recommendations include the following:

Offer surveillance to:

  • All patients with Peutz-Jeghers syndrome (carriers of LKB1/STK11 mutation)
  • All carriers of CDKN2A mutation
  • Carriers of BRCA2, BRCA1, PALB2, ATM, MLH1, MSH2 or MSH6 mutation, with ≥1 affected first-degree blood relative
  • Individuals with ≥1 first-degree relative with pancreatic cancer who also have a first-degree relative with pancreatic cancer (familial pancreatic cancer kindred)

Start surveillance:

  • Familial pancreatic cancer kindred (without known mutation): age 50 or 55 years or 10 years younger than the youngest affected blood relative (YABR)
  • CDKN2A Peutz-Jegher syndrome: age 40 years
  • BRCA2, ATM, PALB2, BRCA1, MLH1/MSH2: age 45 or 50 years or 10 years younger than YABR

Measure MRI/MRCP+EUS + fasting blood glucose and/or HbA1c at baseline.

During follow-up, routine fasting blood glucose and/or HbA1, and alternate MRI/MRCP and EUS.

Serum CA 19-9 if concerning features on imaging.

EUS-FNA only for:

  • Solid lesions ≥5 mm
  • Cystic lesions with worrisome features
  • Asymptomatic main pancreatic duct (MPD) strictures (with/without mass)

CT only for:

  • Solid lesions (any size)
  • Asymptomatic MPD strictures of unknown aetiology (without mass)

Follow-up:

  • 12 months: no abnormalities or concerning abnormalities
  • 3-6 months: if concerning abnormalities not indicated for immediate surgery

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