Pancreatic cancer

Pancreatic cancer is the sixth most common cause of cancer-related death in Europe.

Most common presentation is at 65 to 75 years of age with painless obstructive jaundice and weight loss. Generally presents late with advanced disease.

Surgical resection offers the only hope for cure. Chemotherapy and radiotherapy, as primary treatment modalities, produce a small but statistically significant benefit. Adjuvant chemotherapy prolongs survival.

Only a minority (5% to 10%) of patients can undergo potentially curative surgery: these patients have a 5-year survival of up to 22%, which decreases to <2% in the presence of distant metastasis.

Patients with metastatic disease (50% to 55%) have a limited survival of only 3 to 6 months.

Chemotherapy or immunotherapy may provide some benefit for selected patients.

'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/default.aspx The course of pancreatic cancer has been shown to follow a linear progression model from pre-invasive 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 tumours of the pancreas, see the BMJ Best Practice topic VIPoma.