Background |
Who is at Risk? |
History & Physical Examination
Family History |
Surveillance |
Treatment |
Outcome
The next place to delve for valuable information is from the history of affected family
members. Sometimes these family members may have died, but relatives, especially spouses,
can be invaluable repositories of information. The following key questions should be
addressed. What were the presenting symptoms of the affected family members? What was the
duration of symptoms before the affected member was diagnosed? What are the ages of affected
family members at the time of diagnosis? Is there any suggestion of hereditary pancreatitis
(chronic relapsing abdominal pain/diarrhea often extending in to childhood)? Is there a history
of diabetes in the family? Are there any other cancers in the family (especially melanoma, GI
cancers, breast and ovarian cancers)? Is the patient an Ashkenazi Jew? By assessing these questions,
one can determine whether the pancreatic cancer develops in the context of specific hereditary cancer
syndromes such as Hereditary Non-polyposis Colon Cancer (GI cancers, breast and ovarian cancers) or
due to specific tumor suppressor genes, such as BRCA2 (breast and ovarian cancers; Ashkenazi Jews)
and p16 (melanoma). In addition, the diagnosis of Hereditary Pancreatitis can be considered and
genetic testing performed.
Most importantly one should try to get a feeling for the pace and character of the disease in a
particular family and determine the timing and tempo of surveillance. For example, some pancreatic
cancer families will present with diabetes or diarrhea that may precede cancer by years or decades,
while other families develop cancer abruptly, with no warning signs. Some families will develop cancer
at a late age, while others at an early age.