Pancreatic Cancer

 

Clinical Background

Pancreatic cancer, a common cancer in the U.S., has historically been associated with a high mortality rate.

Epidemiology

  • Incidence – 9-10/100,000
  • Age – peak incidence in 60s
  • Sex – M>F (minimal)
  • Ethnicity – 30-40% higher incidence in African Americans

Risk Factors

  • Low socioeconomic status
  • Male gender
  • Tobacco use
  • Presence of chronic disease states
    • Chronic pancreatitis
    • Diabetes mellitus
    • Prior cholecystectomy
  • Occupational exposures
    • DDT, benzidine, dry cleaning agents, polychlorinated biphenyls (PCBs)
  • Genetics
    • Family history of pancreatic cancer
    • Familial syndromes
      • BRCA1 and BRCA2 mutations
      • Familial atypical multiple mole melanoma syndrome (FAMMM)
      • Peutz-Jeghers syndrome (PJS)
      • Hereditary nonpolyposis colorectal cancer (HNPCC)
      • Ataxia-telangiectasia syndrome (A-T)
      • Hereditary pancreatitis syndrome
      • Von Hipple-Lindau syndrome (VHL)
      • Li-Fraumeni syndrome (LFS)
      • Familial pancreatic cancer

Pathophysiology

  • Tumor is usually ductal adenocarcinoma
    • May also have mucinous cystadenocarcinomic variants
  • Uncommon neuroendocrine tumors may also affect the pancreas
    • Insulinoma
    • Glucagonoma
  • 70-80% of tumors are located in head of the pancreas
  • Tumors may manifest solely as cysts

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
  • If tumors are neuroendocrine in nature, patient may have endocrine syndromes as initial presentation (eg, hypoglycemia)