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.

Stage Description App. % of cases Treatment options Median survival
Local/resectable Disease is confined to the pancreas and is clearly separated from surrounding blood vessels 15 Surgery; postoperative chemotherapy and/or radiation may also be offered 17 months
Locally advanced / unresectable Disease encases or compresses surrounding blood vessels, or has directly extended into adjacent structures 40 Chemotherapy (most commonly gemcitabine-based) and/or radiation. In very rare instances, cancers that respond well to initial treatment may subsequently be surgically resected. 8-9 months
Metastatic Evidence of extrapancreatic spread to distant organs (liver, lungs, etc.) 45 Chemotherapy (most commonly gemcitabine-based); investigational trials 4-6 months

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

7966-pancan-ribbon-pancreatic-cancer.gif