Pancreatic cancer

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

Most common presentation is at aged 65-74 years 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 3-6 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/guidelines/category_1 ​​ 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 VIPoma.