Table 3

Summary of the main recommendations of the 2019 International Cancer of the Pancreas Surveillance (CAPS) Consortium

  • All patients with Peutz-Jeghers syndrome (carriers of a germline LKB1/STK11 gene mutation)

  • All carriers of a germline CDKN2A mutation

  • Carriers of a germline BRCA2, BRCA1, PALB2, ATM, MLH1, MSH2, or MSH6 gene mutation with at least one affected first-degree blood relative

  • Individuals who have at least one first-degree relative with pancreatic cancer who in turn also has a first-degree relative with pancreatic cancer (familial pancreatic cancer kindred)

W hen (at what a ge ) ?
  • Age to initiate surveillance depends on an individual’s gene mutation status and family history

Familial pancreatic cancer kindred
(without a known germline mutation)
Start at age 50 or 55* or 10 years younger than the youngest affected blood relative
Mutation carriers: For CDKN2A†, Peutz-Jegher syndrome, start at age 40; BRCA2,ATM, PALB2 BRCA1, MLH1/MSH2 start at age 45 or 50 or 10 years younger than youngest affected blood relative
  • There is no consensus on the age to end surveillance

H ow ?
At baseline
  • MRI/MRCP+EUS + fasting blood glucose and/or HbA1c

During follow-up
  • Alternate MRI/MRCP and EUS (no consensus if and how to alternate)

  • Routinely test fasting blood glucose and/or HbA1c

On indication
  • Serum CA 19–9

  • If concerning features on imaging

  • EUS-FNA only for

  • Solid lesions of ≥5 mm

  • Cystic lesions with worrisome features

  • Asymptomatic MPD strictures (with or without mass)

  • CT only for

  • Solid lesions, regardless of size

  • Asymptomatic MPD strictures of unknown aetiology (without mass)

Intervals and surgery
12 Months
  • If no abnormalities, or only non-concerning abnormalities

(eg, pancreatic cysts without worrisome features)
3 or 6 Months
  • If concerning abnormalities for which immediate surgery is not indicated

(see figure 2 for details)
  • If positive FNA and/or a high suspicion of malignancy on imaging (see figure 2 for details)

  • When surgery is indicated, perform an oncological radical resection at a specialty centre

The goal of surveillance is to detect and treat the following pathological lesions
  • Stage I pancreatic cancer, confined to the pancreas, resected with negative margins

  • Pancreatic cancer precursor lesions with high-grade dysplasia (PanIN or IPMN)

  • *Consensus as to when to start surveillance was not reached.

  • †Literature-based recommendation.

  • ATM, ataxia telangiectasia mutated; BRCA2, breast cancer 2; CDKN2A, cyclin-dependent kinase inhibitor 2A; CT, computed tomography; EUS, endoscopic ultrasound; FNA, fine-needle aspiration; HbA1c, hemoglobin A1c; IPMN, intraductal papillary mucinous neoplasm; MLH1, mutL homolog 1; MPD, main pancreatic duct; MRI/MRCP, magnetic resonance imaging/magnetic retrograde cholangiopancreatography; MSH2, mutS homolog 2; MSH6, mutS homolog 6; PALB2, partner and localizer of BRCA2; PanIN, pancreatic intraepithelial neoplasia; STK11, serine/ threonine kinase 11.