2018 / 5 January

Pancreatic Cancer


Pancreatic cancer is responsible for 7% of all cancer-related deaths, and it is now the third leading cause of cancer-related deaths in both women and men. It’s considered a highly lethal disease, for which the relative 1-year survival rate for pancreatic cancer is only 28%. Patients often present with advanced disease, and at the time of diagnosis 52% have a distant disease, and 26% have regional spread.

80 percent of all pancreatic cancers are adenocarcinomas of the ductal epithelium, and around 75% of all pancreatic carcinomas are located within the head or neck of the pancreas leading to obstructive jaundice. Approximately 15-20% occur in the body of the pancreas, and 5-10% occur in the tail.

Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.

There is no standard screening programme in patients at high risk of pancreatic cancer (family history of pancreatic cancer and chronic pancreatitis especially > 20 years), Early diagnosis and the treatment are challenges. The initial symptoms of pancreatic cancer are nonspecific and subtle in onset. Patients often present with abdominal pain radiating to back, weight loss, nausea, fatigue.

Patients with pancreatic cancer may present with Trousseau syndrome, which is migratory thrombophlebitis that occurs as a result of the tissue factor by advanced pancreatic tumors. Obstructive jaundice associated with palpable, nontender gallbladder is known as Courvoisier sign may be present too.

Treatment:

  • Surgery: Pancreaticoduodenectomy or Whipple Procedure, total pancreatectomy and distal pancreatectomy. Potentially curative treatment.
  • Chemotherapy: adjuvant chemotherapy (gemcitabine or S-1, an oral fluoropyrimidine derivative) and patients who are not surgical candidates, but have good performance status can be treated with FOLFIRINOX (LV5-FU [leucovorin/5-fluorouracil] plus oxaliplatin plus irinotecan)
  • Radiation therapy

All patients with any stage of pancreatic cancer can appropriately be considered candidates for clinical trials.

References

  • Dunphy EP. Pancreatic cancer: a review and update. Clin J Oncol Nurs. 2008 Oct;12(5):735-41. doi: 10.1188/08.CJON.735-741. (link)
  • Yabar CS, Winter JM. Pancreatic Cancer: A Review. Gastroenterol Clin North Am. 2016 Sep;45(3):429-45. doi: 10.1016/j.gtc.2016.04.003. (link)
  • Kamisawa T, Wood LD, Itoi T, Takaori K. Pancreatic cancer. Lancet. 2016 Jul 2;388(10039):73-85. doi: 10.1016/S0140-6736(16)00141-0. Epub 2016 Jan 30. (link)
  • Muniraj T, Jamidar PA, Aslanian HR. Pancreatic cancer: a comprehensive review and update. Dis Mon. 2013 Nov;59(11):368-402. doi:10.1016/j.disamonth.2013.08. (link)

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