Pancreatic ductal adenocarcinoma has a very high mortality rate which has been only minimally improved in the last 30 years. This high mortality is closely related to late diagnosis, which is usually made when the tumor is large and has extensively infiltrated neighboring tissues or distant metastases are already present. This is a paradoxical situation for a tumor that requires nearly 15 years to develop since the first founding mutation. Response to chemotherapy under such late circumstances is poor, resistance is frequent, and prolongation of survival is almost negligible. Early surgery has been, and still is, the only approach with a slightly better outcome. Unfortunately, the relapse percentage after surgery is still very high. In fact, early surgery clearly requires early diagnosis. Despite all the advances in diagnostic methods, the available tools for improving these results are scarce. Serum tumor markers permit a late diagnosis, but their contribution to an improved therapeutic result is very limited. On the other hand, effective screening methods for high-risk populations have not been fully developed as yet. This paper discusses the difficulties of early diagnosis, evaluates whether the available diagnostic tools are adequate, and proposes some simple and not-so-simple measures to improve it.
胰腺导管腺癌的死亡率极高，过去30年间改善甚微。这种高死亡率与晚期诊断密切相关，通常确诊时肿瘤已体积较大、广泛浸润邻近组织或已出现远处转移。对于这种从首次基因突变到发展成型需要近15年的肿瘤而言，这种诊断现状形成了一种矛盾局面。在如此晚期的阶段，化疗反应差、耐药频发，生存期的延长几乎可以忽略不计。早期手术曾是、且目前仍是唯一能带来稍好疗效的治疗手段，但遗憾的是术后复发率仍然居高不下。实际上，早期手术显然需要早期诊断作为前提。尽管诊断方法不断进步，但能改善当前诊断困境的有效工具仍然匮乏。血清肿瘤标志物虽能实现晚期诊断，但对改善治疗效果的贡献极为有限。另一方面，针对高危人群的有效筛查方法迄今尚未完全建立。本文探讨了早期诊断面临的困境，评估现有诊断工具的适用性，并提出若干简易及复杂的改进措施。
肿瘤(癌症)患者之家