1031
HLAVNÍ506722701005185134178232252
TÉMA533422701003981147194
Current401733701003976100125160198225
trends42583370100255085123161190
in446433701001552
the453233701002664100
diagnosis46483370100375287125163202231246275
of493933701003858
pancreatic501333701003772110141165200234261277307
cancer533633701003065103133168192
|5584227010018
3655617227010059102136
/35568043010757
Vnitř36328043010771118137165192
Lék.3843804301074184122140
2022;68(6):363-3704003804301074487128172187232277301343365379424467510537578619660
/46838043010757
VNITŘNÍ47598043010792153173218267326347
LÉKAŘSTVÍ5127804301074185131189236280326378400
www.casopisvnitrnilekarstvi.cz42580430107651332012142542953293774274464795215705896176436927117307748128548809159449871007102310631101
imaging42562301071890130178196242290
modalities734623010769116165205223241268286328361
with111462301076079106153
complementary128662301073681153202220263335378425451491517558
methods.1863623010769112139186233282314330
Additionally,221262301074895144161189207253301340358376415426
current265762301073682108134176223248
management425763010774114163203253297370415463490
options93476301074898126145193241274
are122876301074167110
outlined.135876301074896124143162210254304320
Risk4251014013868101153217
factors6771014013845104154200262308360
The565118301074292136
lifetime72011830107224064107135154227272
risk101111830107294881119
of1149118301075074
developing1243118301075195136179198246296316363413
PDAC16761183010747104154203
is1899118301072154
approximately1972118301074393143170217255274347388415458477517
1.5%2509118301074657102166
in2695118301072068
the2783118301073078122
general425132301074993141185212253272
population7171323010756105155204223263290309357406
(8).114213230107317395109
Modifiable12701323010777125175194218238278328347391
risk168113230107335285122
factors1823132301073072113143190217251
include2093132301072673114133180230274
dietary2386132301075674118146187214257
habits,2662132301075596145164193227243
obesity,425146301074898144177196224267279
type723146301073578129174
29171463010750
diabetes987146301075675115165210238281315
mellitus13221463010780125144163181210258291
(DM),1633146301073089159182195
excess1848146301075191130173207240
alcohol2108146301074867107154203252272
consumption,2399146301074794143176223297347375394442491507
and425160301074189138
tobacco583160301073481131172213252298
use.901160301075487131146
Among10671603010759133181230279
lifestyle136616030107254468111145174216236280
risk166616030107335285122
factors,1808160301073072113143189216251267
cigarette2094160301074765114155182224252283325
smoking24391603010740113162200221268318
has2777160301075495128
the425174301072877121
strongest56617430107417097145194244288322351
association937174301074882116164206225266293312361410
with1367174301077291120168
PDAC15551743010752110161211
(17,1786174301073070108114
18).1920174301075190113126
Estimates2066174301074984113132206248275318352
suggest2438174301074088138187232266295
that2753174301073584125152
smokers4251883010734107155194237263298
are742188301074066109
approximately871188301074089139166213251271344385412454474514
twice1404188301072795114154196
as1620188301074073
likely171318830107183674117136176
to1909188301072773
develop2002188301074892133176195243293
PDAC23151883010744101151201
compared2535188301073986160210251278321371
with425202301076483110157
their601202301072472115133158
non-smoker779202301074491139166199271318356398424
counterparts1222202301073682129176202244269319359385415449
(19).169020230107205996118130
Obesity,18392023010756106150183200227269280
defined2138202301074588111130177221270
by2427202301074584
body2530202301074594143182
mass27312023010769109142174
index425216301071967116160200
(BMI)645216301072772142162185
≥308502163010757100144
kg/m2,1013216301074290123194238253
carries1285216301074486112139159202236
an1541216301074492
increased1653216301072370111137180221254298348
likelihood202121630107234179122141159207256305355
of2396216301075175
developing2491216301075397137180200248298317365414
PDAC4252303010745103154203
compared648230301074794169219261287331381
to1049230301073582
individuals1151230301072573123142183203253300341361394
with1564230301077292120169
normal17532303010755104131206247266
range2039230301073375124173218
BMI22772303010752123142
(hazard2439230301073080121158201227276
ratio2735230301073375103122170
of425244301074872
1.15–1.53)51724430107445594132178216227272314335
(20).871244301072568111134147
DM10382443010759129
has1186244301074990123
been1329244301075196140189
correlated1537244301074188115142185204245272314364
with1921244301076685113161
development2102244301075094135178197245295370414462489
of2610244301074973
PDAC27032443010746103153203
(pooled425258301072474123172192236286
relative73125830107287190131158176218261
risk101125830107294881118
of1149258301075074
2.1),1242258301074661100117131
although139325830107426189137186234283331
PDAC17442583010747104154204
itself196725830107214984128147171
is2158258301072053
a22312583010742
risk229325830107284880118
factor2431258301072567108138185211
for2662258301072573100
de‑2782258301075094123
veloping425272301074183103150200219267316
DM7602723010755125
(19,90527230107206097109
21,103427230107418090
22).1144272301074084106119
Diets1283272301075574117145179
heavy1482272301074589129168211
on1713272301074492
processed1825272301074673120161203237270314363
meat,22082723010770114154181197
high-fructose2424272301074564113160188212239287328358404437481
beverages,425286301075095135179205247296340374390
and834286301074694143
saturated997286301073880107155182223250293343
fat136028630107287097
are1477286301074572114
associated1611286301074679112161202221261288330381
with2011286301077089117165
obesity,21962863010752103148181199227270282
type2497286301073375126171
226882863010748
DM,27562863010763133149
and425300301074189138
PDAC583300301074299149199
(23).801300301072164108129142
Furthermore,963300301073984111142190234261335383410453468
fatty145030030107216390121163
infiltration163330030107166487107126154180222249268316364
of2017300301074569
the2106300301072573117
pancreas2243300301074688136176203246286319
has2582300301074586119
been2721300301074791136184
correlated425314301074087114141184203244271313363
with808314301076887115164
development991314301075296137180199248298372416464491
of1502314301075175
pancreatic1596314301075395143183210253293320339379
intraepithelial199531430107216996123165209258277306354398417436476495
neoplasias,2510314301075195144194214254288306346379395
precursors425328301075077120161209235269318345379
to823328301072875
PDAC9183283010745102152202
(24).1139328301072467107128142
Non-modifiable5653423010757106154182257305355373397417457506526570
risk115434230107244376113
factors1287342301072062102133179206240
include1547342301071563103122169219263
age,1829342301073887131145
sex,1994342301073075114131
area,2145342301073763106146162
and2327342301073785134
genetic2481342301074690138182209228268
sus‑2769342301073077110136
ceptibility.425356301074083132160179228247266284312355367
Most8123563010768117150179
cases1011356301073980113157191
of1222356301074670
PDAC13123563010744101151200
are1532356301073966109
sporadic,1660356301073281131158199249267308324
but2003356301074897125
10-15%2148356301074281111150188252
are2420356301073965108
estimated2548356301074276105123197238265307357
to425370301072874
be519370301075398
attributable637370301074471102129148197246274315365384428
to1085370301073178
inherited1183370301072270118162189208236278329
risk153137030107304982120
factors1670370301072770110140187214248
(16,1938370301072767106122
25,2079370301074892106
26).2204370301074890112126
Several2349370301074690130174200242261
genetic2629370301075397145189217236276
susceptibility425384301073482116158201252281300351371390409438482
syndromes927384301074183133184211259335380415
that1362384301073685127155
are1537384301074976120
associated1677384301074983117167209228270297341392
with2090384301077393121171
an2281384301074998
increased2399384301072675117144188230264309360
risk278038430107345487126
of425398301074872
developing517398301075498138182201249299318366416
PDAC9523983010751108158207
have1179398301075394134177
been13763983010755100144192
identified,1588398301072473117165192211235255299349364
particularly1972398301075596123154172213260279320346366406
Peutz-Jeghers2398398301075092140168207234260304354402447473507
syndrome,425412301073475124173200247321365379
familial824412301072971144163182200240259
atypical1103412301074673116166185226267286
multiple14094123010778126145173192241261305
mole17334123010779128147191
and1944412301074694143
melanoma21074123010779123142183231279353394
syndrome,2521412301073879128178204251325370384
hereditary425426301074892119162212231259300326369
breast814426301075582125165199228
and1061426301074795144
ovary1225426301075394135162205
cancer1449426301074688136176219245
syndrome,1714426301073980129179205252326370385
Lynch2119426301074581130171219
syndrome,2357426301074081130179206253327371386
ata‑2762426301074774115143
xia-telangiectasia,42544030107395898126154196215256304353372415456487528561579619635
and1080440301073885135
hereditary1234440301074690116159209227255297323366
pancreatitis1620440301074688136176202245285312331359378410
(27),2050440301072164105129143
although221244030107385785133181229279327
a25584403010738
detailed2616440301074689117159177196240290
overview425454301074787129155198217260324
of768454301074468
these855454301072471115148191
is1065454301071547
beyond1131454301074690129176224272
the1422454301072572115
scope1556454301073070116165209
of1784454301074468
this187145430107247290122
review.2012454301072365105124166230243
The2274454301073887130
risk242345430107234274111
of2553454301074468
develo‑2640454301074588128170189236265
ping425468301074968115163
PDAC608468301074197147195
increases822468301071663103129171210243286319
further116146830107206893124171215241
with1421468301076180107154
age;1595468301073785129143
median17574683010770113163181220268
is2044468301071547
652110468301074182
years2212468301073678118143177
(4).24084683010720618295
However,25224683010753101164207247290315327
a28684683010737
recent425482301072769111153201228
US673482301075393
study786482301073059107157197
evaluating1003482301074081122141189229256275323372
trends139548230107255295143192225
in1640482301071563
cancer1723482301073779127167210236
occurrence1979482301074586125172199226269317357400
among23984823010738112160209258
young2676482301073684132180229
adults425496301074190138156184219
showed664496301073078127191235285
a9684963010738
disproportionate102649630107466597146173220270320346377396444493533560603
rise164949630107234275119
in1788496301071664
the1871496301072573117
incidence2008496301071664104123172216264305347
of2375496301074569
various2463496301073879106125173221254
obe‑2737496301074595140168
sity-related42551030107345280123150178221241281309351401
malignancies,8465103010781122141159208257298346386405449483499
including1365510301072573114133180230249297346
PDAC,17315103010752109160209225
among19765103010748121170219268
individuals2264510301072674123142183203252300340359392
25–492676510301075195141188230
years425524301074083123149184
old628524301075474123
(23).771524301072972116137150
This941524301074898116149
observation11105243010753103137181208252293320339387436
may15655243010780121160
be17445243010756101
related186552430107327594135162204254
to2139524301073481
increasing2239524301072573113140183223256274322372
rates2630524301073374102144178
of2828524301075377
obesity425538301074898143177195223266
and710538301074088138
type867538301072770120165
210525383010743
DM11155383010757127
(28).1262538301072366108131144
The1426538301074090134
incidence1580538301071866106125174218266307349
of1949538301074771
PDAC20405383010744101151201
is2260538301071851
overall2331538301074787130157198217236
higher2587538301074765115163207233
in2840538301071866
men;4255523010774118166181
this62555230107287695128
gap772552301074990139
is931552301071952
even1002552301074485128176
more11985523010773122149192
pronounced1410552301074976123172220269317357400450
in1879552301071967
developed1966552301074993133177196244294339389
countries2375552301074087135183210236256300333
(29).2728552301072467110132145
Clinical425577401385688121185218268329362
presentation8225774013863109169221280344389450495528591654
In565594301071967
current652594301074795122149193241268
practice,940594301075684126166197216256299314
the1274594301073483127
diagnosis1421594301075675115165213262296314347
PDAC17885943010752110160210
is2018594301072558
frequently2096594301073058102152200244293320339379
delayed,24955943010756100120160200243293309
as2824594301074881
symptoms425608301073373146194220266338370
are814608301073762104
often93760830107436697138185
few,1141608301072062125137
if1297608301071538
any,1354608301073683120131
and1504608301073784132
vague.1654608301073777125172214228
Consistent1901608301074793140172189221249290337363
with2283608301076079106153
this245560830107237088120
fact,2594608301071960100129144
only2757608301074491109148
a4256223010741
minority486622301077897145193220239267310
of816622301075276
patients912622301075496123142186234261296
diagnosed1227622301075473113162210259292337387
with1633622301077089117166
PDAC18186223010750107158207
present2045622301075481124158202250277
with2342622301076989117165
resectable2527622301073174108152193223265314334378
disease.425636301074968100145185218262277
Most7226363010772120154183
patients925636301075193120139183231258292
(85–90%)1237636301072668111157201246314335
present1592636301075279122155199248274
with1886636301076786114163
either206863630107466593141185212
locally2299636301072270111153171190230
advanced2549636301074392133175223263306356
(unresectable)425650301072468115141183216260301330371420439482503
or948650301074470
metastatic10386503010769113140181214242283310328368
disease142565030107456396139179211255
(30).1699650301072062105127140
Those1859650301073887134167211
who20896503010761109157
do2265650301074693
develop2377650301074689129172191238287
symp‑2684650301073070144193221
toms425664301072876151184
usually630664301075588136178197216257
have907664301075597137181
non-specific11086643010756105155183218268313355374399419460
complaints:1588664301074795170220240282301349377412428
epigastric20366643010751101121171212246276303323364
or2420664301075583
back2523664301075799141179
pain,27226643010757100119167183
nausea,425678301074889136169214254270
bloating,714678301075574123164191210258307323
abdominal1057678301074595145193267286334375394
fullness,147067830107297796115163207241274290
or1780678301075279
change1879678301074593133182231275
in2174678301072371
stool2265678301073867114163182
consistency,2467678301074592140173191224253296344384427438
all42569230107416078
that523692301072977118145
can687692301074183131
be838692301075095
often953692301074872104146195
understandably1167692301074997146190217251280322370419460509529569
attributed175669230107416899126145195243271314364
to2139692301072976
alternative,223469230107426189131158207247275293334378392
benign2646692301075095143162211259
causes,425706301074082129162206240256
and701706301074089138
thus859706301072776123156
can1035706301074081129
stall1184706301073463104123142
the1345706301072876121
diagnostic1485706301074968108158206254288317335376
process1880706301075077124165208241275
(19,2175706301072363101113
31,230870630107448393
32).2421706301074485107120
The565720301074292136
clinical72072030107436280128147187229247
features987720301072670110137185211254288
that1295720301073078119146
occur1461720301075091130178204
with1685720301076887115163
the1868720301073078123
highest2010720301075170119167211245274
frequency230372030107265497147195239287327370
at2692720301074471
the2783720301073078122
time425734301072746118161
of605734301074468
diagnosis692734301074563102151198245278295327
include1038734301071663102121167215259
abdominal1316734301073785134182255273320359378
pain1713734301074686104151
(40–60%),1883734301072161106153199243309330343
abnormal2245734301073786134181207280320339
liver260373430107153373115141
fun‑2763734301072068115142
ction42574830107406988135183
tests62774830107256699128162
(~50%),808748301072170112154221242255
jaundice1082748301071656102150198217256298
(~30%),1399748301072170110152219240253
new-onset1671748301074588152179229277309353380
DM20707483010755124
(13–20%),221374830107205996141180223289310323
dyspepsia2555748301074685119167211260293311350
(~20%),425762301072474110153221242256
nausea700762301075192139172216256
or976762301075077
vomiting1073762301074390164183211230278327
(~16%),1420762301072676113152218239253
back1693762301075293134172
pain1884762301075294112160
(~12%),2064762301072676114151217239252
and2336762301074391140
weight24967623010767111129178226253
loss2769762301072169103136
(~10%)425776301072474111151218240
(19,685776301072868106118
33).823776301074990111125
Symptoms967776301074784159208236283357390
also137777630107456497145
depend1542776301075498147192240290
on18527763010752101
the1973776301073281125
location2117776301072473114155182201249298
of2435776301075276
the2531776301073381125
tumor2676776301073381154203230
within304762301076483111158176223
the329062301072471115
pancreas.342462301074687134174200242282315331
Most3774623010766114147175
tumors396962301072471144191218252
(60–70%)424062301072061105153192233299320
arise45806230107376381114157
from47566230107204894167
the494262301072572116
head507762301074488127176
or527262301074471
neck536262301074588129166
of304776301074872
the313976301072674118
pancreas327776301074990138179205248288322
and361876301074088137
are377576301074066109
more3904763010772120147190
likely41147630107183674117136176
to431076301072673
present440376301074875118152196244271
with469476301076382111159
biliary48727630107496887105145172215
obstruction510776301074696130159185234274305324372420
leading304790301071962102151169217266
to333290301072471
painless342290301074687106153172215248281
jaundice.372390301071656103150199217257299314
In405690301071663
contrast,413990301073682131157183225257286302
tumors446090301072572145193220254
of473390301074468
the482090301072573116
pancreatic495690301074687135175201243283310328368
body534390301074795145185
tend3047104301072869117166
to3232104301072470
invade3321104301071663102143191235
adjacent3575104301073786104144184226273299
vascular3894104301073778110150197216256282
structures419510430107305885132172202249275317350
and4565104301073784133
are4717104301073863106
more48421043010770118144186
likely504710430107163471114132172
to5238104301072470
cause5328104301073677124156200
back3047118301074991131168
pain3235118301074687106153
on3407118301074593
presentation;3519118301074773116149193241267308335354401449463
tail400211830107246584102
tumors4124118301072472145193219253
can4397118301073677125
often4541118301074569100142190
grow4750118301074672118183
unimpeded4952118301074492110183232277326370419
due5391118301074592136
to3047132301072874
fewer3141132301072164129172199
anatomical3359132301073886127154200274293333375394
neighbors3772132301074590108157205255304331365
(19).415613230107216199121134
Malignant43101323010767108126145194242282330357
obstruction4687132301074595128157184232273303322370418
of5125132301074569
the5213132301072573117
main53501323010771111130178
pancreatic3047146301075091139180206249289317335376
duct34421463010753100141171
(MPD)3633146301072795141198220
can3872146301074486134
result4025146301073073107154173201
in4246146301072270
symptoms4335146301073879153203230277351384
of4739146301075175
pancreatic4834146301075395143183210253293320339379
enzyme5233146301074795132175250294
insufficiency304716030107196799146170198217257276320368408450
(diarrhea,351716030107216786126152179228272312328
flatulence,386516030107204283110158177220268309351366
steatorrhea,4250160301073160102142169216243270318362402418
and4688160301073885135
postprandial4842160301074796129158208235276324374392432451
abdo‑5313160301073887137185214
minal3047174301077492140181200
pain)3267174301074991109157179
and3465174301074189139
occasionally3624174301074789127169202220268317358377395435
in4079174301071967
acute4165174301074182130158200
pancreatitis4385174301075091139180206249289317335363382415
(19,4820174301072463101114
34).4953174301074489110124
Importantly,3187188301071992142191218249290339365384424436
pancreatogenic3643188301075092140181207250290317364414458506525565
(type422818830107255193144189
3c)4437188301074584107
DM45641883010759129
has4713188301074990123
recently4856188301072770112154202229248288
become5164188301075195137183257302
a54851883010742
major30472023010773113132179206
topic.3272202301072470120139178194
It3486202301071543
refers354820230107236589132158191
to3759202301072470
diabetes3848202301074664104153197224266299
associated4167202301073770103150191209249276318367
with4553202301076280108156
disease472820230107456496139179212255
of5003202301074468
the5090202301072472115
exocrine5225202301074079125166192211258302
part3047216301075091118149
of3215216301074771
the3306216301072674119
pancreas3444216301074990138179206248289322
and3786216301073987137
is3942216301071851
most40122163010773121155184
often4216216301074670102144192
caused4428216301073980128161205255
by4703216301074888
chronic4810216301073987113161209228268
pancreatitis,5098216301074890138178205248288315334362381413429
but3047230301075098126
it3193230301072250
can3262230301074385133
also341423030107446396144
be3578230301075297
a36952303010743
paraneoplastic3758230301075394121162210255303354373414447476495535
manifestation43132303010776117165184208251285314355382401449498
of4831230301075074
PDAC.49252303010748105155205221
Moreover,51662303010772121148191240280323350361
it3047244301071947
could3114244301074592140159208
fit334224430107294977
the3439244301073381125
early3584244301074989116135175
diagnosis3779244301075573114163211260293311344
concept4143244301074592141181224273301
based4464244301075596130174224
on47082443010753102
the4829244301073482126
patient‘s4975244301075597124143187235262280312
meta‑53062443010780124152193221
bolic3047258301075099119137177
profile.3244258301075481128152172191235249
Sharma3513258301074694135161236276
et3809258301074876
al.390525830107456480
reported4005258301073174123172199230273323
that4348258301073280121148
an4516258301074593
increase4629258301072371111138181221254299
in4947258301072471
fasting5038258301072870104133151199249
blood5306258301075574122171222
glucose3047272301074967114154200233277
levels3343272301071660100143162194
may35562723010770110149
precede3724272301074673115156198248291
the4035272301072472116
diagnosis4170272301074564104152200248281299331
of4521272301074468
PDAC4608272301074298148197
by4824272301074685
up4929272301074493
to5041272301072571
351312723010741
years5191272301073679119145179
(35).5389272301072163104126139
Furthermore,3047286301074287114145193237264338387413456471
Sah3538286301074082130
et3687286301074370
al.377728630107405874
described3871286301074892125166192212261306356
342472863010742
distinct430928630107486699128147195235265
phases4594286301074897138171215249
prior486328630107487594142169
the5052286301072674119
diagnosis5190286301074866107156204253286304337
of3047300301074872
PDAC31393003010746103153203
based3362300301075192125170220
on3601300301075098
metabolic37193003010775119147189238287307325366
and4104300301074391140
soft4264300301073583107139
tissue442230030107294881114161205
changes:4647300301074290130178228272305321
phase49873003010751100141174218
152253003010745
(30–185290300301072568111159198237
months;30473143010772119167192239271285
hyperglycemia)3351314301074481130174199246264303341382454472511532
characterized3902314301073582121147187226256297322341376418466
by4387314301074584
isolated448931430107154794113152178219268
hyperglycemia,4776314301074481130173199246264302341382454471510526
phase5320314301074693132164207
230473283010743
(18–6311032830107205997143190
months;33193283010769117165191238271285
pre-cachexia)3623328301074672115143185226265313356395414453475
with4117328301076179107154
hyperglycemia4290328301074583132176202250268307346388460479518
and4827328301073785133
decreases4979328301074589129155197237269313346
in5344328301071562
se‑5425328301073074102
rum3047342301072674147
lipids,321334230107153382101149182197
body3429342301074695144184
weight,36323423010761104122171218244260
and3911342301073785133
subcutaneous4064342301073076125165212240281328372420467500
abdominal4583342301073786135183256274321361380
fat,498234230107206288104
and5105342301073885134
phase5258342301074694134167210
354873423010741
(6-0304735630107246593140
months;32063563010769117165191238271285
cachexia)3510356301073677117164207246265304325
including3855356301071562102120166215233280328
loss420335630107156295128
of4350356301074467
visceral443735630107365587127169195235254
fat471035630107206188
with4817356301076179107154
sarcopenia499035630107307197135181230274322339379
(36).5388356301072062105126139
Diagnostic30473814013872105165230294356408452486536
approach36183814013860124189235298359409473
It3187398301071947
is3253398301071648
not3321398301074593120
possible3460398301074796129162180229249292
to3772398301072571
reliably386339830107236685103143192212251
diagnose4134398301074664104153201249282326
a44803983010737
patient4537398301074688115133177225251
with4808398301076180108156
PDAC4984398301074298148197
based5201398301074688121165214
on5435398301074593
symptoms3047412301073475149199226273347380
and3447412301074694144
signs3610412301073957107155188
alone.3817412301074766114162207221
Awareness40584123010758122163189232280325358392
of4469412301075478
risk456641230107325284122
factors4708412301072971111142188215249
may49774123010779120159
lead5156412301072468108158
to5333412301073380
an5433412301074694
earlier3047426301074484110130148192218
and3285426301074694144
more34484263010779128155198
aggressive3666426301074695144171214247281299340383
evaluation4069426301074990131150198238265284332381
in4470426301072472
patients4561426301075597124143187235262296
who48774263010770119167
present5064426301075582125159203251278
with5362426301077089117165
symptoms3047440301073373146194221266339371
suspicious3436440301073076108156174213231278325357
for381244030107196692
the3923440301072471114
disease.405544030107456395138177209252266
Traditional434044030107385898147164192210256304343361
methods47204403010769113139186234282314
of5053440301074467
diagnosing5139440301074562102150197244276294340388
PDAC30474543010744100149197
include3263454301071562101120166214257
serum353945430107297298145217
tumor3775454301072471143190216
markers,40104543010769109134171213239272287
imaging4316454301071687127175193240288
methods,46234543010769112139186233282314329
and4971454301073784132
endoscopic5122454301073986134181214253299348366405
ultrasound304746830107486795121163196245293341390
(EUS)3457468301072263118158182
with3658468301076382110158
or3836468301074673
without3928468301076382110158207255283
biopsy.4231468301074767115165198239251
The4502468301073989133
employment46554683010741115164184232272346391439466
of5140468301074670
multiple52304683010771118137165184233253297
diagnostic3047482301074968108157205254287316335375
modalities34424823010776124174215234252280299343376
can3838482301074283132
help3989482301075094114163
to4172482301072976
detect4267482301075195123166207237
PDAC45244823010747104154203
in4747482301072168
the4835482301073078122
early4977482301074585112131171
stage5168482301073564106155199
and5387482301074290140
thus3047496301072878126160
improve32284963010726100151179227268313
survival.3561496301074189116161182224266286302
An38844963010760110
overview4014496301075697141168213234278345
of4379496301075681
the4480496301073585130
diagnostic4630496301075776118168217267301331351392
work-up50424963010773122150189215265316
of5378496301075681
a54794963010748
suspected3047510301073481114163208249279322372
pancreatic3439510301074991139179206249289316335375
mass38345103010774114148181
is4035510301071951
outlined4106510301074896124143162210254304
in4430510301071866
Fig.4516510301074260109125
246615103010744
(37,4724510301072467107113
38).4857510301074487110123
Laboratory3047536401254394147199235284320373408462
testing3537536401253684126162186239291
The3187552301074394140
only33485523010756106126167
routinely3536552301073483133162182232277298339
used3896552301075690136187
serological4104552301074287115164184234286305347390410
marker45355523010782124152192237264
in4820552301072676
the4916552301073686131
diagnosis5068552301075777119170219270304324358
of5446552301075681
PDAC30475663010745102152202
is3269566301072356
carbohydrate3344566301074586113163212261299348374416443485
antigen3849566301074593120139188232280
(CA)4149566301072878132156
19-9.4324566301074987116160174
Nevertheless,45175663010762106147190217248296340359403437470486
the5023566301073281125
sensitivity5168566301073882130163181209228269288317359
and3047580301074189138
specificity3205580301073484129170188212232272291319362
of3586580301074973
CA36795803010752106
19-93805580301074482112156
in3981580301071967
the4068580301072877121
diagnosis4208580301075069109158207255288307339
of4567580301074973
early4660580301074484110130170
PDAC48505803010746103153202
are5072580301074268111
not5203580301074997124
high,5347580301074968117165180
which30475943010764112130170217
limits3283594301071634106125152186
its348859430107164378
clinical358559430107365573120138177218237
application.3841594301073786135154172212253279298345393409
The4269594301073887130
marker44195943010769110135173216242
maintains46805943010770110128175201242260307340
a50395943010737
sensitivity5095594301073074121154171199217258277304346
of5460594301074468
79–81%3047608301074485132177216276
and3343608301073784133
specificity3495608301073079123164182205225264283310352
of3866608301074568
82–90%3953608301074182125168213279
for425260830107206793
the4364608301072572116
diagnosis4499608301074564103152199247280298330
of4848608301074468
PDAC4935608301074298148196
in5151608301071562
sympto‑5233608301073070144192220266294
matic30476223010774114141160200
patients3267622301074688115133177225252287
(19,357362230107216198110
39),3703622301074183105118
and3841622301073885135
its399562230107164479
elevation4093622301074160104144186213231279328
signifies444062230107314998146164188208251285
advanced4744622301073887129170218258301350
disease511462230107466497141181214258
and5392622301073885135
poor3047636301075099148175
prognosis3241636301075077124174222271304322355
(40–42).3616636301072465111159206247269282
However,39186363010756105170213254297323335
as4273636301074174
PDAC43676363010745102152202
is4588636301071952
usually4660636301074780127168187206246
asymptomatic4925636301074174115190240267314388429456475515
at5460636301074068
the3047650301072876120
early3187650301074383109129169
stage,3376650301073261103152196211
the3607650301072775119
positive3746650301074998131150178196238281
predictive4046650301074976119169188228259277318362
value4427650301074082101148192
of4639650301074771
CA47306503010750105
19-94854650301074381111155
is5029650301071850
only5099650301074796115155
0.9%5273650301074459101169
in5461650301071966
this304766430107287695127
setting3194664301073378105136155203252
(43,3466664301072365106120
44).3606664301074491112125
Furthermore,3751664301074187113144193237263338386413456471
the4241664301072876120
elevation4381664301074363107147189216235283331
of4732664301074872
CA48236643010751106
19-94948664301074482112156
can5124664301073981129
also527366430107405992140
be5433664301074994
caused3047678301074082130163207258
by3324678301075796
other3440678301075582131175202
conditions,3662678301074794142192211239258306355388404
including4086678301072674115134181231250298347
benign44536783010757102150169218267
diseases4739678301075675108152193226270304
(pancreatitis,5063678301073181123171212239282322349368397416448465
cirrhosis,304769230107395783109156204236254285300
biliary336669230107466482100139164206
obstruction,3591692301074493125153179226266295313360407422
and4032692301073783132
acute4183692301073676122149191
cholangitis)4393692301073683130149188235283301328346378398
(45–47)4810692301072060100145191230253
and5082692301073784132
different523369230107456286112154180222269294
malignancies30477063010774114133152201249290338378397441474
(colorectal,3541706301072865112132180207250291321363382397
gastric,3957706301075394127156183202243258
and4235706301074593142
uterine4397706301075280123149168216260
cancers)4677706301074486134174217243277299
(38).4995706301072870114136150
Moreover,51647063010774123150193242282325352363
CA30477203010751105
19-93172720301074179109153
is3345720301071648
not3413720301074594121
expressed3554720301074180130157200234267312362
in3935720301071664
some4019720301073179153198
individuals4236720301071664114132173193242289330349381
with4637720301076282110158
a48157203010738
specific4872720301073180125167185209229269
genotype,5161720301074690138187214257307352367
and3047734301074189138
only32057343010751100119159
65%3384734301074789154
of3557734301075276
patients3652734301075395122141185233260295
with3966734301076988116164
resectable4150734301073073106151192222263313333377
PDAC45467343010749106156206
have4771734301075293132175
elevated4966734301074766110151193220262312
serum5298734301073781108156230
levels3047748301071963104147166199
(40,3265748301072768113128
48).3413748301074692114127
Due35607483010760109153
to3733748301073076
all382974830107436281
these3929748301073078123156201
reasons,4149748301072972112145194242275291
CA44607483010754108
19-94587748301074684114158
is4765748301072154
not4838748301075199126
recommended4984748301072972113160234307352400449493543
for304776230107247198
routine3165762301073279127155174222266
screening,3451762301073979106149194242260308358373
although384476230107466593141190238287335
its419976230107245287
value4306762301074687106154198
as4524762301074679
a46237623010746
screening4689762301073979106149194242260308358
tool5066762301073480129149
is5235762301072456
being53117623010755100119167216
revisited3047776301072770110130162181209251301
(49).3368776301072870112134147
Serial3535776301074690117136176195
measurements37507763010778123163196243269312386430478505540
of4310776301075276
CA44067763010756110
19-94536776301074886116160
have4716776301075293133176
a49127763010745
role497777630107317898142
in5138776301072472
monito‑52297763010779127176194222269298