Clinical review 63: Diabetes and pancreatic cancer: clues to the early diagnosis of pancreatic malignancy.

Overview

PURPOSE: To review the relationship between pancreatic cancer and diabetes, particularly as this pertains to the early detection of pancreatic cancer. DATA SOURCES: Studies published from 1985 to 1992 identified by computerized literature searches of Index Medicus and Medline and hand searches of referenced articles. STUDY SELECTION: Selected epidemiology studies were those exploring the relationship between diabetes and pancreatic cancer. DATA EXTRACTION: Data concerning the risk of developing pancreatic cancer given a history of diabetes was evaluated with particular attention given to the duration of diabetes before a diagnosis of pancreatic cancer. The characteristics of diabetes presenting within the 2 yr before the diagnosis of pancreatic cancer were also investigated. RESULTS OF DATA SYNTHESIS: Whereas diabetes is a risk factor for the development of pancreatic cancer, the diagnosis of a pancreatic tumor in some cases is preceded by a brief history of diabetes, which appears to be caused by the malignancy itself. This diabetes may be atypical with regard to a lack of family history of diabetes, absence of obesity, and a rapid progression to insulin dependence. CONCLUSIONS: Recognition of atypical diabetes as an early manifestation of pancreatic cancer could lead to earlier diagnosis of tumors at a stage when they are still amenable to resection and cure.