Pancreatic carcinoma

Alternative names

Pancreatic cancer; Cancer - pancreas

Definition

Pancreatic carcinoma is a malignancy (cancer) of the pancreas.

Causes, incidence, and risk factors

Pancreatic cancer is the 4th leading cause of death from cancer in the U.S. The disease is slightly more common in men than in women, and risk increases with age.

The cause is unknown, but it is more common in smokers and in obese individuals. Almost 1/3 of cases of pancreatic carcinoma can be attributed to cigarette smoking. There is controversy as to whether type 2 diabetes is a risk factor for pancreatic cancer. A minority of cases are known to be related to hereditary syndromes.

Symptoms

• Weight loss
  
• Abdominal pain
  
• Loss of appetite
  
• Jaundice
  
• Nausea and vomiting
  
• Weakness
  
• Fatigue
  
• Diarrhea
  
• Indigestion
  
• Back pain
  
• Clay-colored stools
  
• Paleness
  
• Depression
  

Signs and tests

• ERCP
  
• Abdominal CT scan
  
• Pancreatic biopsy
  
• Abdominal ultrasound
  
• Abdominal MRI
  

This disease may also alter the results of the following tests:

• Serum bilirubin
  
• Liver function tests
  

Treatment

At the time of diagnosis, only about 20% of pancreatic tumors can be removed by surgery. The standard procedure is called a pancreaticoduodenectomy (Whipple procedure).

This surgery for pancreatic cancer should be done at centers that perform the procedure frequently. Some studies suggest that surgery is best performed at hospitals that perform at least 9 of these surgeries per year.

When the tumor is confined to the pancreas but cannot be removed, a combination of radiation therapy and chemotherapy may be recommended. When the tumor has spread (metastasized) to other organs such as the liver, chemotherapy alone is usually used. The standard chemotherapy agent is gemcitabine, but other drugs may be used. Gemcitabine provides clinical improvement in approximately 25% of patients.