| Who? |
- All patients with Peutz-Jeghers syndrome (carriers of a germline LKB1/STK11 gene mutation)
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- All carriers of a germline CDKN2A mutation
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- Carriers of a germline BRCA2, BRCA1, PALB2, ATM, MLH1, MSH2, or MSH6 gene mutation with at least 1 affected first-degree blood relative
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- Individuals who have at least 1 first-degree relative with pancreatic cancer who in turn also has a first-degree relative with pancreatic cancer (familial pancreatic cancer kindred)
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| When (at what age)? |
- Age to initiate surveillance depends on an individual's gene mutation status and family history
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- Familial pancreatic cancer kindred (without a known germline mutation):
- Start at age 50 or 55*, or 10 years younger than the youngest affected blood relative
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- Mutation carriers:
- For CDKN2A¶ and Peutz-Jeghers syndrome, start at age 40
- For BRCA2, ATM, PALB2, BRCA1, and MLH1/MSH2, start at age 45 or 50, or 10 years younger than the youngest affected blood relative
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- There is no consensus on the age to end surveillance
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| How? |
| At baseline |
- MRI/MRCP + EUS + fasting blood glucose and/or HbA1c
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| During follow-up |
- Alternate MRI/MRCP and EUS (no consensus on if and how to alternate)
- Routinely test fasting blood glucose and/or HbA1c
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| On indication |
- Serum CA 19-9:
- If concerning features on imaging
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- EUS-FNA only for:
- Solid lesions of ≥5 mm
- Cystic lesions with worrisome features
- Asymptomatic MPD strictures (with or without mass)
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- CT only for:
- Solid lesions, regardless of size
- Asymptomatic MPD strictures of unknown etiology (without mass)
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| Intervals and surgery |
- 12 months:
- If no abnormalities or only nonconcerning abnormalities (eg, pancreatic cysts without worrisome features)
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- 3 or 6 months:
- If concerning abnormalities for which immediate surgery is not indicated (refer to UpToDate text)
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- Surgery:
- If positive FNA and/or a high suspicion of malignancy on imaging (refer to UpToDate text)
- When surgery is indicated, perform an oncologic radical resection at a specialty center
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| Goals |
- The goal of surveillance is to detect and treat the following pathologic lesions:
- Stage I pancreatic cancer, confined to the pancreas, resected with negative margins
- Pancreatic cancer precursor lesions with high-grade dysplasia (PanIN or IPMN)
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