Updated guideline for management of people at increased pancreatic cancer risk

The International Cancer of the Pancreas Screening (CAPS) Consortium has released updated guidance for the management of individuals with increased risk of pancreatic cancer based on family history or germline mutation status (high-risk individuals). The recommendations are published in the BMJ journal Gut.

The guideline recommends pancreatic surveillance for selected high-risk individuals to detect early pancreatic cancer and its high-grade precursors but should be performed in a research setting by multidisciplinary teams in centers with appropriate expertise.

Other Key Recommendations include:

• 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)
  
  
  
  


• Surveillance should be started in:
  
  
  
  • 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
  
  
  
  


• MRI/MRCP+EUS + fasting blood glucose and/or HbA1c at baseline should be measured.


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


• Serum CA 19-9 should be performed if concerning features on imaging.


• EUS-FNA should be performed only for:
  
  
  
  • Solid lesions ≥5 mm
  
  
  • Cystic lesions with worrisome features
  
  
  • Asymptomatic main pancreatic duct (MPD) strictures (with/without mass)
  
  
  
  


• CT should be performed only for:
  
  
  
  • Solid lesions (any size)
  
  
  • Asymptomatic MPD strictures of unknown aetiology (without mass)
  
  
  
  


• Follow-up should be performed for:
  
  
  
  • 12 months if no abnormalities or concerning abnormalities occur
  
  
  • 3-6 months if concerning abnormalities are not indicated for immediate surgery
  
  
  
  

"Until more evidence supporting these recommendations is available, the benefits, risks and costs of surveillance of pancreatic surveillance need additional evaluation," concluded the authors.

The guideline, "Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium," is published in the BMJ journal Gut.

DOI: http://dx.doi.org/10.1136/gutjnl-2019-319352

Journal Information: Gut