Pancreatic cancer

Pancreatic cancer is the third most common cause of cancer-related death in the US.

Most common presentation is at ages 65-74 years with painless obstructive jaundice and weight loss. Early symptoms are nonspecific. Generally presents late with advanced disease.

Surgical resection offers the only hope for cure. Chemotherapy and radiation therapy, as primary treatment modalities, produce a small but statistically significant benefit. Adjuvant chemotherapy prolongs survival. Clinical trial enrollment should be considered for all patients.

Only a minority (10% to 15%) of patients can undergo potentially curative surgery: these patients have a 5-year survival of up to 43%, which decreases to <4% in the presence of distant metastasis.

Patients with metastatic disease (50% to 55%) have a poor prognosis. Chemotherapy may extend survival by several months. Immunotherapy may provide some benefit for selected patients.

Supportive care includes biliary stenting for relief of obstruction, pancreatic enzyme supplementation, and celiac plexus block or neurolysis.

"Pancreatic cancer" refers to primary pancreatic ductal adenocarcinoma, which accounts for >90% of all pancreatic neoplasms.[1]National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: pancreatic adenocarcinoma [internet publication]. https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf ​​ The course of pancreatic cancer has been shown to follow a linear progression model from preinvasive pancreatic intraepithelial neoplastic lesions to invasive ductal adenocarcinoma. Two additional well-defined precursor lesions are the intraductal papillary mucinous neoplasm and the mucinous cystic neoplasm.[2]Noë M, Brosens LA. Pathology of pancreatic cancer precursor lesions. Surg Pathol Clin. 2016 Dec;9(4):561-80. http://www.ncbi.nlm.nih.gov/pubmed/27926360?tool=bestpractice.com

For diagnosis and management of neuroendocrine tumors of the pancreas, see VIPoma.