CHEMOTHERAPY AND MANAGEMENT OF PANCREATIC CANCER

ABSTRACT:

Pancreatic cancer remains one of the most fatal cancers in the world, and is often difficult to treat because the disease runs without symptoms a long time, is biologically aggressive, and responds poorly to available treatments. Although there has been notable progress in the development of molecular diagnostics and imaging technologies, timely detection of disease remains a major clinical challenge, and has a significant impact on prognosis and is associated with continued high mortality. This study has provided a thorough overview of the epidemiological trends, predisposing risk factors, pathophysiological mechanisms and key molecular alterations involved in pancreatic cancer progression and has been focused on oncogenic mutations in KRAS, TP53, SMAD4 and p16/CDKN2A. Immunological complexity of the disease is discussed in terms of the tumor microenvironment (stromal remodeling, desmoplasia, immunosuppressive cells and T-cell exhaustion as obstacles for effective immune surveillance). Diagnostic modalities are compared including computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and endoscopic ultrasound (EUS) in terms of their diagnostic sensitivity and clinical applicability. The current standard-of-care therapies such as surgical resection, systemic chemotherapy, radiation therapy, and palliative therapies are also discussed critically, as well as their limitations, such as drug resistance mechanisms and impaired drug penetration in the dense tumor stroma. While the backbone of systemic treatment is based on gemcitabine, the results in terms of overall survival have not improved significantly in the last decades, strongly suggesting an urgent need for more effective therapeutic approaches. It is important, therefore, to understand the molecular, metabolic and immunological aspects of pancreatic cancer in order to develop new diagnostic strategies and precision-targeted treatments that will improve patient prognosis.as