Familial pancreatic cancer (Part II): Surveillance, diagnostic tests, and surgical strategies.

We have provided a description of the current state of knowledge relevant to familial/hereditary pancreatic cancer. Since the most important clinical ramifications of this disease, whose incidence and mortality are essentially the same, rests upon its earlier detection, we have also characterized available diagnostic tests, surgical strategies, and current knowledge about its pathology. We believe that advances in control of pancreatic cancer will be heavily impacted by progress in the search for new and better diagnostic tests. These could include monoclonal antibodies targeted to pancreatic tumor tissue, and possibly pancreatic site-specific P450's, as well as biomolecular/genetic techniques, particularly when focused on individuals at high risk. Thus, family studies are important in this disease because if an autosomal dominantly inherited form of pancreatic cancer is delineated, one could identify individuals at high risk early in life. Comparison could then be made with individuals in branches of the family where the disease is not segregating. Thus, there would be a greater potential for discovery of methods for early detection with evaluation of sensitivity and specificity in families wherein the predictability for pancreatic cancer occurrence is high.