 Introduction/Background Prevalence, Etiology, Treatment, and Prognosis According to the American Cancer Society, the number of new pancreatic cancer cases estimated in the United States in 2017 is 53,670 [1]. The estimated number of deaths is 43,090 in 2017, with pancreatic adenocarcinoma remaining the fourth leading cause of cancer-related death in the United States. Difficulty in early detection and lack of effective screening methods invariably results in an advanced stage at presentation and poor prognosis. Associated risk factors include tobacco use (20% of patients), family history of pancreatic cancer (two or more first-degree relatives with pancreatic cancer reported in 10% of patients), chronic pancreatitis, diabetes, obesity, hereditary pancreatitis [2-4] and genetic alterations such as BRCA1, BRCA2, PALB2, p16 gene mutations, Lynch syndrome, and Peutz-Jeghers syndrome [5,6]. Screening is not currently recommended for the general population (US Preventive Services Task Force gives a D recommendation) [7]. However, some have suggested that screening patients at high risk of developing pancreatic cancer is feasible, while acknowledging that data for cost- effectiveness and benefit are still required [8]. To date, the most suitable imaging technology for such screening is unclear [5]. No specific tumor markers for pancreatic cancer exist, and although most patients will demonstrate elevation in serum cancer antigen 19-9, this has low specificity and is more often used to indicate disease progression. Pancreatic cancer develops insidiously in the exocrine cells, and as such, early disease is often asymptomatic or presents with vague symptoms such as loss of appetite, fatigue, and general malaise. Consequently, 80% to 85% of patients present with advanced disease without the option of surgical resection [9]. Overall survival for pancreatic cancer is 28% after 1 year and 7% after 5 years [1].
Staging of Pancreatic Ductal Adenocarcinoma.  Introduction/Background Prevalence, Etiology, Treatment, and Prognosis According to the American Cancer Society, the number of new pancreatic cancer cases estimated in the United States in 2017 is 53,670 [1]. The estimated number of deaths is 43,090 in 2017, with pancreatic adenocarcinoma remaining the fourth leading cause of cancer-related death in the United States. Difficulty in early detection and lack of effective screening methods invariably results in an advanced stage at presentation and poor prognosis. Associated risk factors include tobacco use (20% of patients), family history of pancreatic cancer (two or more first-degree relatives with pancreatic cancer reported in 10% of patients), chronic pancreatitis, diabetes, obesity, hereditary pancreatitis [2-4] and genetic alterations such as BRCA1, BRCA2, PALB2, p16 gene mutations, Lynch syndrome, and Peutz-Jeghers syndrome [5,6]. Screening is not currently recommended for the general population (US Preventive Services Task Force gives a D recommendation) [7]. However, some have suggested that screening patients at high risk of developing pancreatic cancer is feasible, while acknowledging that data for cost- effectiveness and benefit are still required [8]. To date, the most suitable imaging technology for such screening is unclear [5]. No specific tumor markers for pancreatic cancer exist, and although most patients will demonstrate elevation in serum cancer antigen 19-9, this has low specificity and is more often used to indicate disease progression. Pancreatic cancer develops insidiously in the exocrine cells, and as such, early disease is often asymptomatic or presents with vague symptoms such as loss of appetite, fatigue, and general malaise. Consequently, 80% to 85% of patients present with advanced disease without the option of surgical resection [9]. Overall survival for pancreatic cancer is 28% after 1 year and 7% after 5 years [1].