Article: Pancreatic cancer

Pancreatic cancer (also called cancer of the pancreas) is represented by the growth of a malignant tumour within the pancreatic gland. Each year about 32,180 individuals in the United States are diagnosed with this condition, with more than 60,000 in Europe. Depending on the extent at the time of diagnosis, the prognosis is generally regarded as poor, with few victims still alive 5 years after diagnosis, and complete remission still extremely rare.

Most pancreatic tumors are adenocarcinomas (M8140/3). Neuroendocrine tumors (such as insulinomas) are usually benign (M8150/1, M8150/3) and have a completely different diagnostic and therapeutic profile, and are not regarded as cancer in the sense that they are not typically malignant.

Signs and symptoms

Presentation

Early diagnosis of pancreatic cancer is difficult because the symptoms are so non-specific and varied. Common symptoms include abdominal pain, loss of appetite, significant weight loss and painless jaundice.

Jaundice occurs when the tumour grows and pressure obstructs the common bile duct, which partially runs through the head of the pancreas. Tumours of the head of the pancreas (approximately 60% of cases) will more easily give rise to such symptoms.

Predisposing factors

Risk factors for pancreatic cancer include [1]:

• Age
• Male gender
• African ethnicity
• Smoking
• Diets high in meat
• Obesity
• Diabetes
• Chronic pancreatitis has been linked, but is not known to be causal.
• Occupational exposure to certain pesticides, dyes, and chemicals related to gasoline
• Family history
• Helicobacter pylori infection

Diagnosis

Courvoisier's law defines the presence of jaundice and a painlessly distended gallbladder as strongly indicative of pancreatic cancer, and may be used to distinguish pancreatic cancer from gallstones.

Pancreatic cancer is usually discovered during the course of the evaluation of aforementioned symptoms. Liver function tests may show a combination of results indicative of bile duct obstruction (raised bilirubin, γ-glutamyl transpeptidase and alkaline phosphatase levels). Imaging studies, such as ultrasound or abdominal CT may be used to identify tumors. Endoscopic ultrasound (EUS) is another procedure that can help visualize the tumor and obtain tissue to establish the diagnosis.

Treatment

Treatment of pancreatic cancer depends on the stage of the cancer [2] Recent advances have made resection of tumors that were previously unrescetable due to blood vessel involvement possible. The Whipple procedure is the most common surgical treatment for cancers involving the head of the pancreas.

Recent advances in the treatment of pancreatic cancer: For number of years, treatment of pancreatic cancer was limited to 5-FU alone. Then Gemcitabine was introduced. Gemcitabine had no survival advantage in pancreatic cancer compared to 5-FU, but the drug was FDA approved for pancreatic cancer based on better improvement in symptoms compared to 5-FU.

Targeted therapy using several new drugs[3] is showing significant improvements in the treatment of pancreatic cancer. New drugs for the treatment of pancreatic cancer include: erlotinib, cetuximab, bevacizumab, tipifarnib. These drugs hold promise for the future treatment of patients with pancreatic cancer.

Prognosis

Patients diagnosed with pancreatic cancer typically have a poor prognosis because the cancer usually causes no symptoms early on, leading to metastatic disease at time of diagnosis. Median survival from diagnosis is around 3 to 6 months; 5-year survival is 5% [4]. With 32,180 new diagnoses in the United States every year, and 31,800 deaths, mortality approaches 99%, giving pancreatic cancer the #1 fatality rate of all cancers and the #4 cancer killer in the United States amongst both men and women. [5]

Pancreatic cancer occasionally may result in diabetes. The insulin production is hampered and it has been suggested that the cancer can also prompt the onset of diabetes and vice versa. [6]

Prevention

Prevention of pancreatic cancer consists of avoiding risk factors when possible [7]. Cigarette smoking is considered to be the most significant and avoidable risk factor for pancreatic cancer. Maintaining a healthy weight and exercising may be helpful. Additionally, increasing consumption of fruits, vegetables, and whole grains while decreasing red meat intake is recommended.

Awareness

• November is Pancreatic Cancer Awareness Month
• Purple is the traditional color chosen to represent pancreatic cancer
• An estimated 52.7 million dollars was spent on pancreatic cancer research in 2004 of the National Cancer Institute’s (NCI) cancer research budget. This is just a mere 1% of the NCI’s 4.824 billion dollar cancer research budget for 2004. [8]
• Despite the especially lethal nature of pancreatic cancer, the research spending per pancreatic cancer patient is only $1145, the lowest of any leading cancer. [9]