SeminarPancreatic carcinoma
Section snippets
Epidemiology and aetiology
Over the past 20 years, the incidence of pancreatic carcinoma in Europe and North America has remained unchanged, with an estimated 9–10 cases per 100 000 and slightly increased male:female and black:white ratios. Pancreatic cancer currently ranks as the fifth most common cause of cancer-related deaths in western countries. Various risk factors have been implicated and are shown in the panel.1 Other observations include familial aggregation of pancreatic carcinoma and a 13-fold increased risk
Pathology and molecular abnormalities
About 90% of pancreatic tumours are adenocarcinomas with a ductal phenotype. Neuroendocrine tumours and acinar cell carcinomas represent about 2–5% of all pancreatic tumours. The assumption is that tumorigenesis starts from pluripotent stem cells. However, the presence of such protodifferentiated cells with the capability of transdifferentiation in the adult human pancreas remains elusive. Pancreatic ductal adenocarcinomas are characterised histologically by atypical glands embedded in a dense
Presenting signs
Early symptoms of pancreatic carcinoma, including weight loss, anorexia, epigastric discomfort, and back pain, are often non-specific and vague, so diagnosis may be considerably delayed. Weight loss (usually greater than 10% of body weight) and jaundice due to biliary obstruction are most common in cancer of the pancreatic head, whereas epigastric and back pain are more common in tumours of the body and tail.8 Pain is probably caused by invasion of the tumour into the splanchnic plexus and
Therapy
Surgery is the only curative treatment for pancreatic carcinoma, and outcome is related mainly to tumour stage and histology (eg, neuroendocrine tumour vs adenocarcinoma). Based on the preoperative staging, resectability depends largely on the following factors:
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size (‘magic’ 2–3 cm) and location of the primary tumour
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invasion into the peripancreatic tissue and lymph node involvement
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evidence of vascular infiltration
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presence of distant metastasis.
As a result of better surgical technique,
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