General Information About Pancreatic Cancer
This summary provides information about the treatment of exocrine pancreatic cancer. Other PDQ summaries containing information related to cancer in the pancreas include the following:
- Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment.
- Unusual Cancers of Childhood Treatment (pancreatic cancer during childhood).
Incidence and Mortality
Estimated new cases and deaths from pancreatic cancer in the United States in 2014:
- New cases: 46,420.
- Deaths: 39,590.
The incidence of carcinoma of the pancreas has markedly increased over 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.
- A family history of pancreatic cancer.
- Cigarette smoking.
- Chronic pancreatitis.
Cancers of the pancreas are commonly identified by the site of involvement within the pancreas. Surgical approaches differ for masses in the head, body, tail, or uncinate process of the pancreas.
Pancreatic cancer symptoms depend on the site of the tumor within the pancreas and the degree of tumor involvement.
In the early stages of pancreatic cancer there are not many noticeable symptoms. As the cancer grows, symptoms may include the following:
- Light-colored stools or dark urine.
- Pain in the upper or middle abdomen and back.
- Weight loss for no known reason.
- Loss of appetite.
Diagnostic and Staging Evaluation
Pancreatic cancer is difficult to detect and diagnose for the following reasons:
- There are no noticeable signs or symptoms in the early stages of pancreatic cancer.
- The signs of pancreatic cancer, when present, are like the signs of many other illnesses, such as pancreatitis or an ulcer.
- The pancreas is obscured by other organs in the abdomen and is difficult to visualize clearly on imaging tests.
To appropriately treat pancreatic cancer, it is crucial to evaluate whether the cancer can be resected.
The use of imaging technology may aid in the diagnosis of pancreatic cancer and in the identification of patients with disease that is not amenable to resection. Imaging tests that may be used include the following:
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.
No tumor-specific markers exist for pancreatic cancer; markers such as serum cancer antigen (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.[Level of evidence: 3iDiii] The presence of a normal CA 19-9, however, does not preclude recurrence.
Prognosis and Survival
The primary factors that influence prognosis are:
- Whether the tumor is localized and can be completely resected.
- Whether the tumor has spread to lymph nodes or elsewhere.
Exocrine pancreatic cancer is rarely curable and has an overall survival (OS) rate of less than 6%.
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. For 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 is associated with an actuarial 5-year survival rate of 18% to 24%.[Level of evidence: 3iA]
Surgical resection is the mainstay of curative treatment and provides a survival benefit in patients with small, localized pancreatic tumors. Patients with unresectable, metastatic, or recurrent disease are unlikely to benefit from surgical resection.
Pancreatic tumors are resistant to treatment with chemotherapy and radiation.
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 may be achieved with conventional treatment.
- Surgical or radiologic biliary decompression.
- Relief of gastric outlet obstruction.
- Pain control.
- Psychological care to address the potentially disabling psychological events associated with the diagnosis and treatment of pancreatic cancer.
- American Cancer Society: Cancer Facts and Figures 2014. Atlanta, Ga: American Cancer Society, 2014. Available online. Last accessed November 24, 2014.
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