Pancreatic cancer accounts for only two percent of all new cancers in the United States, but it is the fourth leading cause of cancer deaths. Due to their insidious nature, more than half of all pancreatic cancers have already metastasized at the time of diagnosis.
Until recently, pancreatic cancer was more common in men. However, women now account for 57% of all new cases.
During the past 25 years, survival rates for pancreatic cancer have not improved. Four percent of all patients survive five years; patients with tumors localized to the pancreas have a 17% five-year survival rate. (Jemal A, et al. Cancer statistics, 2004. CA Cancer J Clin 2004;54:8-29)
Confirmed and Putative Risk Factors for Pancreatic Cancer
- Age over 50 years
- Smoking
- Family history of pancreatic cancer
- Hereditary chronic pancreatitis
- Diabetes (long-standing)
- Obesity
- A link between alcohol or coffee consumption and pancreatic cancer has not been established
- Exercise and high fruit and vegetable intake reduce the risk
(Freelove R, Walling A. Pancreatic cancer: diagnosis and management. Am Fam Phys 2006;73(3):485-92)
Signs and Symptoms of Pancreatic Cancer
Symptoms occur late. By the time of diagnosis, 90% of patients have locally advanced or metastatic tumors. Symptoms are usually caused by so-called mass effect, rather than disruption of pancreatic function; location of the tumor within the pancreas (head, body or tail of the organ) determines which signs and symptoms are most prominent:
- Abdominal pain, sometimes severe, which typically radiates to the back
- Jaundice (yellowing of the skin, eyes, and mucous membranes)
- Weight loss
- Fatigue
- Weakness
- Loss of appetite
- Dark urine
- Pale stools
- Nausea and vomiting
- Gastrointestinal bleeding
- Glucose intolerance or diabetes (occurs in up to half of patients as disease progresses)
Diagnosis of Pancreatic Cancer
Diagnostic tests are often based upon how a patient first presents to his or her physician. For example, an individual who exhibits jaundice without significant abdominal pain might first undergo upper endoscopy with radiologic examination of the pancreatic and bile ducts (endoscopic retrograde cholangiopancreatography, or ERCP); this examination would allow concurrent placement of a stent in the bile duct to relieve obstruction.
Other diagnostic modalities include:
- Dual-phase helical CT (the most sensitive modality)
- Abdominal ultrasound
- MRI
- Endoscopic ultrasound (often accompanied by fine-needle biopsy)
- Blood tests to determine levels of CA 19-9, beta-hCG, or CA 72-4 are more useful for following patients after treatment and for determining prognosis. They are not appropriate tools for screening or diagnosis.
Treatment of Pancreatic Cancer
In the US, surgical resection is considered the only potential cure for pancreatic cancer. However, at least 75% of all patients are not surgical candidates at the time of diagnosis.
- Some variation of the Whipple procedure is the operation of choice for treating cancers in the pancreatic head. This involves removal of the head and body of the pancreas, the duodenum, a portion of the jejunum, the gallbladder and common bile duct, and part of the stomach. Mortality rates are significant for this procedure, ranging from 4-18%.
- For operable tumors in the body or tail of the pancreas, distal pancreatectomy and splenectomy are usually performed.
- Chemotherapy in conjunction with surgery may improve survival.
- Chemotherapy and radiation, along with various procedures to alleviate obstruction and other symptoms of tumor invasion, are commonly used for patients with inoperable tumors.
- Pain medications, digestive enzymes, specialized dietary formulas, and hospice care are all useful at various stages of the disease.
Screening for pancreatic cancer is limited to individuals known to be at risk, since current screening techniques are of limited use in the general population. Risk reduction through smoking cessation, healthy eating, and regular physical activity are the mainstays of prevention.
