General Information
Note: Information on pancreatic cancer in children is available in the PDQ summary on Unusual Cancers of Childhood 1.
Note: Estimated new cases and deaths from pancreatic cancer in the United States in 2008:[1]
- New cases: 37,680.
- Deaths: 34,290.
Note: Some citations in the text of this section are followed by a level of
evidence. The PDQ editorial boards use a formal ranking system to help the
reader judge the strength of evidence linked to the reported results of a
therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence 2 for more
information.)
Carcinoma of the pancreas has had a markedly increased incidence during the past
several decades and ranks as the fourth leading cause of cancer death in the
United States. Despite the high mortality rate associated with pancreatic
cancer, its etiology is poorly understood.[2] Cancer of the exocrine pancreas
is rarely curable and has an overall survival (OS) rate of less than 4%.[3] The
highest cure rate occurs if the tumor is truly localized to the pancreas;
however, this stage of the disease accounts for fewer than 20% of cases. For those
patients with localized disease and small cancers (<2 cm) with no
lymph node metastases and no extension beyond the capsule of the pancreas,
complete surgical resection can yield actuarial 5-year survival rates of 18% to
24%.[4][Level of evidence: 3iA] Improvements in imaging technology, including
spiral computed tomographic scans, magnetic resonance imaging scans, positron
emission tomographic scans, endoscopic ultrasound examination, and laparoscopic
staging can aid in the diagnosis and the identification of patients with
disease that is not amenable to resection.[5] In a case series of 228
patients, positive peritoneal cytology had a positive predictive value of 94%,
specificity of 98%, and sensitivity of 25% for determining unresectability.[6]
For patients with advanced cancers, the OS rate of all stages is
less than 1% at 5 years with most patients dying within 1 year.[7-10]
No tumor-specific markers exist for pancreatic cancer; markers such as
serum CA 19-9 have low specificity. Most patients with pancreatic cancer will
have an elevated CA 19-9 at diagnosis. Following or during definitive therapy,
the increase of CA 19-9 levels may identify patients with progressive tumor
growth.[11][Level of evidence: 3iDiii] The presence of a normal CA
19-9, however, does not preclude recurrence.
Patients with any stage of pancreatic cancer can appropriately be considered
candidates for clinical trials because of the poor response to chemotherapy,
radiation therapy, and surgery as conventionally used. Palliation of
symptoms, however, may be achieved with conventional treatment. Symptoms caused by
pancreatic cancer may depend on the site of the tumor within the pancreas and
the degree of involvement. Palliative surgical or radiologic biliary
decompression, relief of gastric outlet obstruction, and pain control may
improve the quality of life while not affecting OS.[12,13]
Palliative efforts may also be directed to the potentially disabling
psychological events associated with the diagnosis and treatment of pancreatic
cancer.[14]
Information about ongoing clinical trials is available from the NCI Web site 3.
References
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American Cancer Society.: Cancer Facts and Figures 2008. Atlanta, Ga: American Cancer Society, 2008. Also available online. 4 Last accessed October 1, 2008.
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Silverman DT, Schiffman M, Everhart J, et al.: Diabetes mellitus, other medical conditions and familial history of cancer as risk factors for pancreatic cancer. Br J Cancer 80 (11): 1830-7, 1999.
[PUBMED Abstract]
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Greenlee RT, Murray T, Bolden S, et al.: Cancer statistics, 2000. CA Cancer J Clin 50 (1): 7-33, 2000 Jan-Feb.
[PUBMED Abstract]
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Yeo CJ, Abrams RA, Grochow LB, et al.: Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg 225 (5): 621-33; discussion 633-6, 1997.
[PUBMED Abstract]
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Riker A, Libutti SK, Bartlett DL: Advances in the early detection, diagnosis, and staging of pancreatic cancer. Surg Oncol 6 (3): 157-69, 1997.
[PUBMED Abstract]
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Merchant NB, Conlon KC, Saigo P, et al.: Positive peritoneal cytology predicts unresectability of pancreatic adenocarcinoma. J Am Coll Surg 188 (4): 421-6, 1999.
[PUBMED Abstract]
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Lillemoe KD: Current management of pancreatic carcinoma. Ann Surg 221 (2): 133-48, 1995.
[PUBMED Abstract]
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Yeo CJ: Pancreatic cancer: 1998 update. J Am Coll Surg 187 (4): 429-42, 1998.
[PUBMED Abstract]
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Nitecki SS, Sarr MG, Colby TV, et al.: Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Ann Surg 221 (1): 59-66, 1995.
[PUBMED Abstract]
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Conlon KC, Klimstra DS, Brennan MF: Long-term survival after curative resection for pancreatic ductal adenocarcinoma. Clinicopathologic analysis of 5-year survivors. Ann Surg 223 (3): 273-9, 1996.
[PUBMED Abstract]
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Willett CG, Daly WJ, Warshaw AL: CA 19-9 is an index of response to neoadjunctive chemoradiation therapy in pancreatic cancer. Am J Surg 172 (4): 350-2, 1996.
[PUBMED Abstract]
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Sohn TA, Lillemoe KD, Cameron JL, et al.: Surgical palliation of unresectable periampullary adenocarcinoma in the 1990s. J Am Coll Surg 188 (6): 658-66; discussion 666-9, 1999.
[PUBMED Abstract]
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Baron TH: Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 344 (22): 1681-7, 2001.
[PUBMED Abstract]
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Passik SD, Breitbart WS: Depression in patients with pancreatic carcinoma. Diagnostic and treatment issues. Cancer 78 (3 Suppl): 615-26, 1996.
[PUBMED Abstract]
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