Article information
Resumen
El cáncer de páncreas (CP) es una enfermedad de difícil diagnóstico y tratamiento. Su pronóstico es ominoso, ya que suele detectarse en fases avanzadas, cuando la posibilidad de cualquier tratamiento curativo no es mayor del 20%. Con la idea de mejorar el pronóstico se están desarrollando las nuevas pautas en las estrategias de cribado, sobre todo con el desarrollo de un nuevo consenso internacional con recomendaciones sobre el manejo de pacientes con alto riesgo de desarrollar un CP. En la línea de mejorar el diagnóstico se confirman la elastografía y los contrastes guiados por ultrasonografía endoscópica (USE) como 2 tecnologías especialmente útiles en este contexto. También hay avances en la punción guiada por USE, con el desarrollo de agujas de histología que aumentan la eficacia diagnóstica y la calidad de las muestras. Finalmente, pocos avances en el tratamiento, confirmándose el papel límite de la neoadyuvancia en tumores localmente avanzados, la eficacia de diferentes estrategias de neurólisis para el tratamiento del dolor, y para el tratamiento de la obstrucción biliar las prótesis metálicas recubiertas parecen ser la mejor opción. Sobre los tumores quísticos de páncreas destacar el desarrollo de la endomicroscopia confocal guiada por USE para mejorar su diagnóstico y la optimización de las estrategias de seguimiento, sobre todo del tumor mucinoso papilar intraductal de rama lateral.
Palabras clave:
Cáncer de páncreas
Tumor quístico de páncreas
Cribado
Diagnóstico
Abstract
Pancreatic cancer is difficult to diagnose and treat. Prognosis is poor, since this disease is usually detected at advanced stages, when the possibilities of any treatment with curative intent are 20% or less. To improve prognosis, new screening strategies are being designed, especially with the development of a new international consensus with recommendations on the management of patients at high risk of developing pancreatic cancer.
Two especially useful techniques in the diagnosis of this disease are elastography and contrast-enhanced endoscopic ultrasound (EUS). Advances have been made in EUS-guided biopsy with the development of histology needles that increase diagnostic efficacy and the quality of the samples. Finally, there have been a few advances in treatment. The role of neoadjuvant therapy in locally advanced tumors and the efficacy of distinct neurolysis strategies in pain therapy have been confirmed. Covered metallic stents seem to be the best option to treat biliary obstruction. A notable development is the development of EUS-guided confocal endomicroscopy to improve the diagnosis and follow-up of cystic tumors of the pancreas, especially intraductal papillary mucinous tumors of the lateral branch.
Keywords:
Pancreatic cancer
Cystic tumor of the pancreas
Screening
Diagnosis
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