Pancreatic cancer is cancer originating in the pancreas.

• Asymptomatic, usually in the disease's early stages
• If a cancer in the head of the pancreas, obstructs the common bile duct, as it runs through the pancreas:
  • Jaundice (i.e. yellow tint in the white of the eyes or skin)
  • Light colored stools
  • Dark urine
• Abdominal pain
• Back pain
• Cachexia (unexplained weight loss)
• Loss of appetite

• Occurs when cells in the pancreas (i.e. glandular organ behind the stomach) begin to multiply out of control and form a mass
• These cancers have the ability to invade other parts of the body

• Tobacco smoking (25% of cases)
• Obesity
• Diabetes
• Certain rare genetic conditions (7%)

Protective factors:

• Stop smoking, decreases the chance of developing pancreatic cancer, and almost returns to that of the general population after 20 years
• Maintain a healthy weight
• Limit consumption of red or processed meat

• Exocrine cancers (99%), which occurs in the exocrine component, which produces digestive enzymes. It includes:
  • Pancreatic adenocarcinoma, the most common (85% of cases). It starts within the part of the pancreas which makes digestive enzymes
  • Non-adenocarcinomas, includes several other types of cancer, can also arise from the cells of the pancreas
• Pancreatic neuroendocrine tumors (PanNET, islet cell tumor) (1.5%), which arise from the hormone-producing cells of the pancreas. They are generally less aggressive than pancreatic adenocarcinoma. It includes:
  • Insulinoma, which is a tumor of the beta cells, that secretes insulin (i.e. reduces blood glucose)
  • Gastrinoma, which is a tumor of the pancreas or duodenum, that secretes excess gastrin (i.e. secretes gastric acid in the stomach) leading to ulceration in the duodenum, stomach and small intestine

• Medical imaging, e.g. U/S or CT
• Blood tests
• Biopsy (examination of tissue samples)

• Staged into 4 stages, from early (stage 1) to late (stage 4)

• Screening, has NOT been found to be effective
• Based upon staging, a combination of:
  • Surgery, the only Tx that can cure the disease, but can also be done to improve the quality of life w/o potential for cure
  • Radiotherapy
  • Chemotherapy
  • Palliative care, recommended early in even those receiving Tx that aims for a cure
• Pain Mx
• Drugs to improve digestion

• Pancreatic adenocarcinoma has very poor prognosis
  • After Dx, 25% of Pt's survive 1 year, and 5% live for 5 years
  • For cancers Dx early, the 5-year survival rate rises to about 20%
• Metastatic spread is usually to, all of which occur in 50%+ of fully advanced cases:
  • Liver
  • Peritoneal cavity
  • Lungs
• Neuroendocrine cancers have better outcomes, at 5 years from Dx, 65% are living, although survival varies considerably depending on the type of tumor

• Sx that are specific enough to suspect pancreatic cancer typically don't develop until the disease has reached an advanced stage, when pancreatic cancer has often metastasized to other parts of the body
• Rarely occurs <40yo
• >50% occur in those >70yo
• 7th most common cause of cancer deaths, resulting in 330k deaths globally
• In the USA, the 4th most common cause of deaths due to cancer
• Occurs most often in the developed world, where 70% of new cases occur annually

• GI cancer