Pancreatic Cancer

Pancreatic cancer– Tumors arise from the exocrine glands (95%) and the endocrine glands (5%) in the pancreas. Ductal adenocarcinomas constitute 80% of all pancreatic tumors. Other histologic types include squamous cell and giant cell carcinomas, sarcomas, plasmacytomas, and lymphomas.

Causes and Incidence

Cigarette smoking is strongly linked to the development of cancer of the pancreas. Other possible predisposing factors include excessive consumption of caffeine, ethanol abuse, high-fat diets, and occupational exposure to solvents and petrochemicals. More than 28,000 cases of pancreatic cancer are diagnosed each year in the United States, and it is the fourth leading cause of cancer death. Men are 1 1/2 to 2 times as susceptible as women.

Disease Process

Most tumors begin in the head of the exocrine gland, obstruct the bile duct, and extend to the duodenum, intestines, and spine. Spread occurs to the regional lymph nodes, and common metastatic sites include the liver and lungs.

Symptoms

Symptoms occur late in the disease and include anorexia; weight loss; flatulence; bloating; constipation; upper abdominal pain, which radiates to the back and abates in a fetal position; jaundice; and thrombophlebitis.

Potential Complications

The prognosis is extremely poor, with a 3% long-term survival rate. Complications include diabetes and alterations in mental status.

Diagnostic Tests

Ultrasound, computed tomography scans, and endoscopic retrograde pancreatography are used to locate masses and to assist in staging of the tumor. The definitive diagnosis is made by needle or tissue biopsy.

Treatments

Surgery
Pancreatectomy or Whipple procedure; bypass of obstructions for palliation.

Drugs
Chemotherapy has not been effective to date.

General
Radiation limits tumor progression but does little for survival rate.