Pancreatic Cancer

Pancreatic Cancer

 

Pancreatic cancer, a common cancer in the U.S., has historically been associated with a poor outcome.

Epidemiology

  • Incidence – 9-10 cases per 100,000
  • Age – peak incidence 60-70 years
  • Gender – M:F, 1:1.3
  • Ethnicity – 30-40% higher rate in African-Americans

Risk Factors

  • Low socioeconomic status
  • Male gender
  • Tobacco abuse
  • Presence of the chronic disease states
    • Chronic pancreatitis
    • Diabetes mellitus
    • Prior cholecystectomy
  • Occupational exposures
    • DDT, benzidine, dry cleaning agents, polychlorinated biphenyls
  • Genetics
    • Increased risk if family history of pancreatic cancer
    • Familial syndromes – BRCA 1 and 2 mutations, familial multiple mole melanoma syndrome, Peutz Jeghers syndrome, hereditary nonpolyposis, colorectal cancer, ataxia-telangiectasia syndrome, hereditary pancreatitis syndrome

Pathophysiology

  • Tumor is usually adenocarcinoma
  • Rare neuroendocrine tumors also affect the pancreas
    • Insulinoma
    • Glucagonoma
  • 70-80% of tumors are located in head of the pancreas

Clinical Presentation

  • No specific early warning symptoms
  • Usually abdominal pain and weight loss
  • Obstructive jaundice if tumor is at the head of the pancreas
  • Late features – ascites, abdominal mass

Diagnosis

  • Laboratory testing
    • CA 19-9 serum antigen testing – sensitivity depends on stage of cancer
      • May be elevated in obstructive jaundice
      • Should be used in conjunction with imaging studies to diagnose pancreatic cancer
    • Serial monitoring recommended to assess follow up after potentially curative surgery or response to palliative chemotherapy
  • Imaging Studies
    • Ultrasound/CT/MRI
    • Endoscopic retrograde cholangiopancreatography (ERCP) to outline extent of ductal involvement

See Also