[Current strategy to cure pancreatic cancer].

For more than a decade extensive retroperitoneal dissection, chemotherapy, or radiotherapy has not prolonged the survival of patients with pancreatic cancer. Two prospective randomized studies addressing the clinical significance of extensive dissection or pancreatic resection for advanced cancer are now in progress. Nonetheless, at present, resection offers the patient the only possibility of cure. Although the diagnosis of curable pancreatic cancer is difficult, recent evidences have given a few hints. The first is pancreatic duct dilatation caused by cancerous stricture. The second is diabetes as a sign of pancreatic cancer. Our prospective pancreatographic screening of diabetic patients selected by our criteria(Table 1) revealed 7 cancers in 98 patients(7.1%). Within 3 years from diagnosis, the prevalence was 15%. Although the 7 cancers were advanced, this suggests that earlier examinations in diabetic patients may possibly lead to earlier diagnosis. The third is a small cystic lesion as a sentinel of pancreatic cancer. Endoscopic retrograde cholangiopancreatography with cytology of the pancreatic juice may show the presence of in situ cancer in patients with a pancreatic cyst. At the moment, careful checks for the presence of these hints seem to be the only strategy to offer a chance for cure to patients with pancreatic cancer.