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

Abstract

To review the relationship between pancreatic cancer and diabetes, particularly as this pertains to the early detection of pancreatic cancer. Studies published from 1985 to 1992 identified by computerized literature searches of Index Medicus and Medline and hand searches of referenced articles. Selected epidemiology studies were those exploring the relationship between diabetes and pancreatic cancer. 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. 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. 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.