Pancreatic cancer: state-of-the-art care

Abstract

(CA Cancer J Clin 2000;50:241-268.) IntroductionPancreatic carcinoma is the fourth leading cause of cancer mortality in the US, with more than 28,000 people deaths attributed to the disease each year.1,2 Considered by many to be one of the deadliest malignancies, pancreatic cancer is associated with a death:incidence ratio of approximately .99.3 Despite this grim picture, significant advances have been made in recent years, both in our understanding of the pathogenesis of the disease and in its clinical management. This article reviews the epidemiology and risk factors of pancreatic cancer, as well as recent developments in the field of molecular genetics and the influence of growth factors on disease progression. Moreover, it serves to update the current thinking about the management of pancreatic cancer, including diagnosis and staging, surgical resection, adjuvant therapy, and palliation. Epidemiology and Risk FactorsThe incidence of pancreatic cancer increased in the US nearly three-fold from 1920 to 1978. Since that time, rates have remained constant, with approximately nine new cases diagnosed per 100,000 population.1 By contrast, in nearly all European countries, the incidence of pancreatic cancer has continued to rise.The risk factors for pancreatic cancer have been extensively studied (Table), 4 with advancing age perhaps the strongest risk factor. Incidence rates for pancreatic cancer increase steadily with age, with over 80% of cases occurring between the ages of 60 and 80. The diagnosis of pancreatic cancer in individuals younger than age 40 is uncommon.The incidence and mortality rates for both male and female African Americans with pancreatic cancer are higher than for whites. Although gender differences in pancreatic cancer incidence have been equalizing over recent years, the disease still occurs more frequently in men. Incidence and mortality rates have increased in women since 1974 while having stabilized or decreased slightly in white men.Several studies in US populations C A C a n c e r J C l i n 2 0 0 0 ; 5 0 : 2 4 1 -2 6 8

Temporal Trends in Pancreatic Cancer

“…Long-term results in patients treated for pancreatic cancer demonstrate only slight variations over the last 30 years with 5-year survival rates of 1-3% (Gudjonsson, 1995;Lillemoe et al, 2000;Tsiotos et al, 1999). Nevertheless, the number of reports describing improving survival trends is growing Wood et al, 2006).…”

“…Pancreatic cancer is one of the most common malignancies of the digestive system and, depending on the geographic area, fourth or fifth leading cause of cancer deaths (Lillemoe et al, 2000;Simon & Printz, 2001). Between 1960 and 1980, the incidence rates had increased significantly in most industrialised countries, including Poland.…”

Pancreato-Biliary Cancers – Diagnosis and Management

“…Ductal infiltrating adenocarcinoma is the most common type of pancreatic cancer with 78% located in the head, 11% in the body and 11% in the tail (Lillemoe et al, 2000;Ghaneh et (Ghaneh et al, 2008). Given the preponderance pancreatic head location of the tumours, painless cholestatic symptoms are the most common presentation (Ghaneh et al, 2008).…”

Risk Factors in Pancreatic Cancer

“…Other demographic factors that are associated with a modest (about 2-fold) increased risk include male gender, Jewish descent and black ethnicity (Lillemoe et al, 2000). Table 1.…”