Pancreatic cancer is a malignant tumour within the pancreatic gland. Each year about 33,000 individuals in the United States are diagnosed with this condition, and more than 60,000 in Europe. Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with few victims still alive five years after diagnosis, and complete remission still extremely rare.
About 95 percent of pancreatic tumors are adenocarcinomas (M8140/3). The remaining 5 percent include other tumors of the exocrine pancreas (e.g. serous cystadenomas), acinar cell cancers, and pancreatic neuroendocrine tumors (such as insulinomas, M8150/1, M8150/3). These tumors have a completely different diagnostic and therapeutic profile, and generally a more favorable prognosis.
Signs and symptoms
Early diagnosis of pancreatic cancer is difficult because the symptoms are so non-specific and varied. Common symptoms include pain in the upper abdomen that typically radiates to the back and is relieved by leaning forward (seen in carcinoma of the body or tail of the pancreas), loss of appetite, significant weight loss and painless jaundice related to bile duct obstruction (carcinoma of the head of the pancreas). All of these symptoms can have multiple other causes. Therefore, pancreatic cancer is often not diagnosed until it is advanced.
Jaundice occurs when the tumor grows and obstructs the common bile duct, which runs partially through the head of the pancreas. Tumours of the head of the pancreas (approximately 60% of cases) are more likely to cause jaundice by this mechanism.
Trousseau's sign, in which blood clots form spontaneously in the portal blood vessels, the deep veins of the extremities, or the superficial veins anywhere on the body, is sometimes associated with pancreatic cancer.
Risk factors for pancreatic cancer include:
- Male gender
- African ethnicity
- Diets high in meat
- 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
- Gingivitis or periodontal disease.
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 conjugated bilirubin, γ-glutamyl transpeptidase and alkaline phosphatase levels). CA19-9 (carbohydrate antigen 19.9) is a tumor marker that is frequently elevated in pancreatic cancer.
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.
Recent research indicates that in pancreatic cancer malignancies, the tumor contains markedly higher levels of certain microRNAs (miRNA) than does the patient's benign pancreatic tissue or that found in other healthy pancreases. This paves the way for two possibilities: 1) a more early but likely expensive genetic and biochemical molecular screening test profile, which would be an innovation in this cancer; and 2) also possible new, creative and more effective therapies based on the various microRNA levels. This opens an exciting new front in confronting a very deadly disease.
Treatment of pancreatic cancer depends on the stage of the cancer. Recent advances have made possible resection (surgical removal) of tumors that were previously unresectable due to blood vessel involvement. The Whipple procedure is the most common surgical treatment for cancers involving the head of the pancreas.
Fluorouracil, gemcitabine, and erlotinib are the chemotherapeutic drug agents of choice. Gemcitabine was approved by the US FDA in 1998 after a clinical trial reported improvements in quality of life in patients with advanced prostate cancer. This marked the first FDA approval of a chemotherapy drug for a non-survival clinical trial endpoint.
On the back of the results of a Canadian led Phase III Randomised Controlled trial involving 569 patients with advanced pancreatic cancer, the US FDA has licensed the use of erlotinib (Tarceva) in combination with gemcitabine as a palliative agent for this tumour. This trial compared the action of gemcitabine/erlotinib vs gemcitabine/placebo and demonstrated improved survival rates, improved tumour response and improved progression free survival rates. The survival improvement with the combination is on the order of less than four weeks, leading some cancer experts to question the incremental value of adding erlotinib to gemcitabine treatment. New trials are now investigating the effect of the above combination in the adjuvant and neoadjuvant setting.
Patients diagnosed with pancreatic cancer typically have a poor prognosis partly 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 much less than 5% With 32,180 new diagnoses in the United States every year, and 31,800 deaths, mortality approaches 99%, giving pancreatic cancer the highest fatality rate of all cancers and the fourth highest cancer killer in the United States amongst both men and women.
Prevention of pancreatic cancer consists of avoiding risk factors when possible 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.
The American Cancer Society recommends increasing consumption of fruits, vegetables, and whole grains while decreasing red meat intake. This has been questioned by several research groups. In 2006 a large prospective cohort study of over 80,000 subjects failed to prove a definite association. The evidence in support of this lies mostly in small case-control studies.
In September 2006, a long-term study concluded that taking Vitamin D can substantially cut the risk of pancreatic cancer (as well as other cancers) by up to 50%. More studies of this have been called for.
Several studies, including one published June 1, 2007, indicate that B vitamins such as B12, B6, and folate, can reduce the risk of pancreatic cancer when consumed in food, but not when ingested in vitamin tablet form.
- November is Pancreatic Cancer Awareness Month
- Purple is the traditional color chosen to represent pancreatic cancer awareness.
- The National Cancer Institute’s cancer research budget was $4.824 billion in 2004, an estimated $52.7 million of which was devoted to pancreatic cancer.
- Research spending per pancreatic cancer patient is $1145, the lowest of any leading cancer.
- For a list of celebrities who have succumbed to this disease, see Category:Pancreatic cancer deaths
- The Pancreatic Cancer Action Network (PanCAN) was created as an advocacy group for pancreatic cancer.
- The national charity Pancreatic Cancer UK works to raise awareness in the UK
- Pancreatic Cancer Action Network (PanCAN)
- The Pancreatic Society of Great Britain and Ireland
- The Johns Hopkins Pancreatic Cancer Web Site
- Rare Pancreatic & Neuroendocrine Cancer Support
- Pancreatic Cancer UK
- Confronting Pancreatic Cancer (Pancreatica.org)
- Cancer of the Pancreas (Cancer Supportive Care Program)
- American Cancer Society: Detailed Guide on Pancreatic Cancer
- The National Familial Pancreas Tumor Registry
- Pancreatic Cancer Collaborative Registry (PCCR)
- The Lustgarten Foundation For Pancreatic Cancer Research
- Ghaneh P, Costello E, Neoptolemos JP (2007). "Biology and management of pancreatic cancer". Gut. 56 (8): 1134–52. doi:10.1136/gut.2006.103333. PMID 17625148.
- Carney CP, Jones L, Woolson RF, Noyes R Jr, Doebbeling BN. Relationship between depression and pancreatic cancer in the general population. Psychosom Med 2003;65:884-8. PMID 14508036.
- Michaud DS, Joshipura K, Giovannucci E, Fuchs CS (2007). "A prospective study of periodontal disease and pancreatic cancer in US male health professionals". J. Natl. Cancer Inst. 99 (2): 171–5. doi:10.1093/jnci/djk021. PMID 17228001.
- FDA approval briefing
- Coughlin, SS (2000 Dec). "Predictors of pancreatic cancer mortality among a large cohort of United States adults". Cancer Causes Control. 11 (10): 915-23. PMID 11142526. Unknown parameter
|coauthors=ignored (help); Check date values in:
- Zheng, W (1993 Sep). "A cohort study of smoking, alcohol consumption, and dietary factors for pancreatic cancer (United States)". Cancer Causes Control. 4 (5): 477-82. PMID 8218880. Unknown parameter
|coauthors=ignored (help); Check date values in:
- Larsson, Susanna (February 2006). "Fruit and vegetable consumption in relation to pancreatic cancer risk: a prospective study". Cancer Epidemiology Biomarkers & Prevention. 15: 301–305. PMID 16492919. Unknown parameter
- "Plasma Folate, Vitamin B6, Vitamin B12, and Homocysteine and Pancreatic Cancer Risk in Four Large Cohorts -- Schernhammer et al. 67 (11): 5553 -- Cancer Research". Retrieved 2007-06-04.
- "United Press International - Consumer Health Daily - Briefing". Retrieved 2007-06-04.