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Pancreatic cancer

Pancreatic cancer
Diagram showing the position of the pancreas, behind the stomach (which is transparent in this schematic).
Specialty
Symptoms
Usual onset40+ years of age[2]
Risk factors
Diagnostic method
PreventionNot smoking, low alcohol intake, maintaining a healthy weight, low red meat diet[5]
Treatment
PrognosisFive year survival rate 13%[6]
Frequency393,800 (2015)[7]
Deaths411,600 (2015)[8]

Pancreatic cancer arises when cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a mass. These cancerous cells have the ability to invade other parts of the body.[9] A number of types of pancreatic cancer are known.[10]

The most common, pancreatic adenocarcinoma, accounts for about 90% of cases,[11] and the term "pancreatic cancer" is sometimes used to refer only to that type.[10] These adenocarcinomas start within the part of the pancreas that makes digestive enzymes.[10] Several other types of cancer, which collectively represent the majority of the non-adenocarcinomas, can also arise from these cells.[10]

About 1–2% of cases of pancreatic cancer are neuroendocrine tumors, which arise from the hormone-producing cells of the pancreas.[10] These are generally less aggressive than pancreatic adenocarcinoma.[10]

Signs and symptoms of the most-common form of pancreatic cancer may include yellow skin, abdominal or back pain, unexplained weight loss, light-colored stools, dark urine, and loss of appetite.[1] Usually, no symptoms are seen in the disease's early stages, and symptoms that are specific enough to suggest pancreatic cancer typically do not develop until the disease has reached an advanced stage.[1][2] By the time of diagnosis, pancreatic cancer has often spread to other parts of the body.[10][12]

Pancreatic cancer rarely occurs before the age of 40, and more than half of cases of pancreatic adenocarcinoma occur in those over 70.[2] Risk factors for pancreatic cancer include tobacco smoking, obesity, diabetes, and certain rare genetic conditions.[2] About 25% of cases are linked to smoking,[3] and 5–10% are linked to inherited genes.[2]

Pancreatic cancer is usually diagnosed by a combination of medical imaging techniques such as ultrasound or computed tomography, blood tests, and examination of tissue samples (biopsy).[3][4] The disease is divided into stages, from early (stage I) to late (stage IV).[12] Screening the general population has not been found to be effective.[13]

The risk of developing pancreatic cancer is lower among non-smokers, and people who maintain a healthy weight and limit their consumption of red or processed meat;[5] however, the risk is greater for men, especially at very high levels of red meat consumption.[14] However, this is in debate, as a study performed by the International Journal of Cancer in 2013 did not find any statistically significant relationship between red meat consumption and pancreatic cancer, finding instead no male connection and only finding positive association of red meat consumption with pancreatic cancer risk in women after restriction to microscopically confirmed cases.[15] Smokers' risk of developing the disease decreases immediately upon quitting, and almost returns to that of the rest of the population after 20 years.[10] Pancreatic cancer can be treated with surgery, radiotherapy, chemotherapy, palliative care, or a combination of these.[1] Treatment options are partly based on the cancer stage.[1] Surgery is the only treatment that can cure pancreatic adenocarcinoma,[12] and may also be done to improve quality of life without the potential for cure.[1][12] Pain management and medications to improve digestion are sometimes needed.[12] Early palliative care is recommended even for those receiving treatment that aims for a cure.[16]

Pancreatic cancer is among the most deadly forms of cancer globally, with one of the lowest survival rates. In 2015, pancreatic cancers of all types resulted in 411,600 deaths globally.[8] Pancreatic cancer is the fifth-most-common cause of death from cancer in the United Kingdom,[17] and the third most-common in the United States.[18] The disease occurs most often in the developed world, where about 70% of the new cases in 2012 originated.[10] Pancreatic adenocarcinoma typically has a very poor prognosis; after diagnosis, 25% of people survive one year and 12% live for five years.[6][10] For cancers diagnosed early, the five-year survival rate rises to about 20%.[19] Neuroendocrine cancers have better outcomes; at five years from diagnosis, 65% of those diagnosed are living, though survival considerably varies depending on the type of tumor.[10]

  1. ^ a b c d e f g "Pancreatic Cancer Treatment (PDQ®) Patient Version". National Cancer Institute. National Institutes of Health. 17 April 2014. Archived from the original on 5 July 2014. Retrieved 8 June 2014.
  2. ^ a b c d e f Ryan DP, Hong TS, Bardeesy N (September 2014). "Pancreatic adenocarcinoma". The New England Journal of Medicine. 371 (11): 1039–49. doi:10.1056/NEJMra1404198. PMID 25207767.
  3. ^ a b c Wolfgang CL, Herman JM, Laheru DA, Klein AP, Erdek MA, Fishman EK, Hruban RH (September 2013). "Recent progress in pancreatic cancer". CA: A Cancer Journal for Clinicians. 63 (5): 318–48. doi:10.3322/caac.21190. PMC 3769458. PMID 23856911.
  4. ^ a b Cite error: The named reference Lancet was invoked but never defined (see the help page).
  5. ^ a b "Can pancreatic cancer be prevented?". American Cancer Society. 11 June 2014. Archived from the original on 13 November 2014. Retrieved 13 November 2014.
  6. ^ a b "Five-Year Pancreatic Cancer Survival Rate Increases to 12%". PANCAN. 2023. Archived from the original on 4 March 2023. Retrieved 3 March 2023.
  7. ^ Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators) (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015". The Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  8. ^ a b Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. (GBD 2015 Mortality and Causes of Death Collaborators) (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". The Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  9. ^ "What Is Cancer? Defining Cancer". National Cancer Institute, National Institutes of Health. 7 March 2014. Archived from the original on 25 June 2014. Retrieved 5 December 2014.
  10. ^ a b c d e f g h i j k World Cancer Report. World Health Organization. 2014. Chapter 5.7. ISBN 978-92-832-0429-9.
  11. ^ Cite error: The named reference Pishvaian2017 was invoked but never defined (see the help page).
  12. ^ a b c d e Bond-Smith G, Banga N, Hammond TM, Imber CJ (May 2012). "Pancreatic adenocarcinoma". BMJ. 344 (may16 1): e2476. doi:10.1136/bmj.e2476. PMID 22592847. S2CID 206894869.
  13. ^ "Draft Recommendation Statement: Pancreatic Cancer: Screening". US Preventive Services Task Force. Retrieved 11 February 2019.
  14. ^ Larsson, S. C.; Wolk, A. (2012). "Red and processed meat consumption and risk of pancreatic cancer: meta-analysis of prospective studies". British Journal of Cancer. 106 (3): 603–607. doi:10.1038/bjc.2011.585. PMC 3273353. PMID 22240790.
  15. ^ Rohrmann, Sabine; et al. (2013). "Meat and fish consumption and risk of pancreatic cancer: Results from the European Prospective Investigation into Cancer and Nutrition". International Journal of Cancer. 132 (3): 617–624. doi:10.1002/ijc.27637. PMID 22610753. S2CID 2613568.
  16. ^ Bardou M, Le Ray I (December 2013). "Treatment of pancreatic cancer: A narrative review of cost-effectiveness studies". Best Practice & Research Clinical Gastroenterology. 27 (6): 881–92. doi:10.1016/j.bpg.2013.09.006. PMID 24182608.
  17. ^ "Cancer facts and figures – Why we exist". Pancreatic Cancer Research Fund. Retrieved 5 April 2019.
  18. ^ "Pancreatic Cancer – Cancer Stat Facts". SEER. Retrieved 4 April 2019.
  19. ^ "Pancreatic Cancer Treatment (PDQ®) Health Professional Version". National Cancer Institute. National Institutes of Health. 21 February 2014. Archived from the original on 22 October 2014. Retrieved 24 November 2014. "The highest cure rate occurs if the tumor is truly localized to the pancreas; however, this stage of disease accounts for less than 20% of cases. In cases 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 is still associated with a low actuarial five-year survival rate of 18% to 24%."

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