{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 36, Ep 5 of 5: Hereditary Pancreatic Cancer and Coordination","html":"","width":"100%","height":180,"duration":1002,"description":"Episode five closes the chapter with hereditary pancreatic cancer and the family-systems coordination that binds every syndrome together. The gating principle is absolute lifetime risk, not relative risk: surveillance begins above roughly five percent, so STK11, CDKN2A, PRSS1, and familial kindreds qualify on genotype alone while BRCA1, BRCA2, ATM, PALB2, and Lynch enter only with a family-history driver. The treatment side ties platinum and PARP inhibitors back to synthetic lethality in homologous-recombination-deficient tumors. The coordination side names the real failure mode, the carrier whose colonoscopy stays on schedule while gynecologic or urologic surveillance lapses, and the board traps around cascade testing, the GINA insurance gap, and the non-actionable variant of uncertain significance.\n \nTopics covered\n\nGermline genes behind pancreatic cancer\nThe absolute-risk surveillance threshold\nWhich carriers qualify on gene alone\nSurveillance starting ages and modality\nPRSS1 hereditary pancreatitis\nSynthetic lethality, platinum, and PARP inhibitors\nMulti-organ coordination and cascade testing\nRisk-reducing surgery and reproductive counseling\nGINA limits and variants of uncertain significance\n\n \nKey decisions\n\nGate pancreatic surveillance on absolute lifetime risk above approximately five percent, above which cancer detection outweighs the false positives, procedural complications, and cyst-driven anxiety below it.\nEnroll STK11, CDKN2A, PRSS1, and familial pancreatic cancer kindreds on genotype or pedigree alone, but enroll BRCA1, BRCA2, ATM, PALB2, and Lynch carriers only with a first-degree or second-degree relative with pancreatic cancer.\nStart surveillance at thirty to thirty-five for STK11, forty for CDKN2A and PRSS1, and fifty for BRCA, ATM, PALB2, and Lynch, or ten years before the earliest family pancreatic cancer, whichever is younger.\nAlternate annual EUS and pancreatic-protocol MRI with MRCP because they are complementary, EUS for solid lesions and...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}