Papafragkakis
Charilaos Papafragkakis, MD
Gastroenterologist - Hepatologist

Pancreatic cancer

Pancreatic cancer is the 14th most common cancer in the world and the 7th in mortality related to cancer overall. The incidence of pancreatic cancer is increasing in the Western world, mainly in the developed countries. It is usually diagnosed at an advanced stage, but occasionally it is diagnosed early, which increases the chances of cure.

The incidence of pancreatic cancer is higher in males than females. Pancreatic cancer rarely presents in people under 30 years old and is mainly a disease of the elderly. Almost 90% of newly diagnosed patients are over 55 years old, with the majority being over 70 years.

Is there genetic predisposition?

Pancreatic cancer is mostly sporadic but also has genetic predisposition. Individuals should be considered to be at risk for familial pancreatic adenocarcinoma if they have

  • Known genetic syndrome associated with pancreatic cancer, including hereditary breast–ovarian cancer syndrome, familial atypical multiple melanoma and mole syndrome, Peutz Jeghers syndrome, Lynch syndrome, or other gene mutations associated with an increased risk of pancreatic adenocarcinoma, have
  • Two relatives with pancreatic adenocarcinoma, where one is a first degree relative
  • Three or more relatives with pancreatic cancer
  • History of hereditary pancreatitis

According to the American College of Gastroenterology guidelines in cases of genetic predisposition surveillance for pancreatic cancer should be with endoscopic ultrasound and/or MRI of the pancreas annually starting at age 50 years, or 10 years younger than the earliest age of pancreatic cancer in the family.

What are the main risk factors?

Smoking. Chronic heavy smokers have been found to be at increased risk for developing pancreatic cancer

Diabetes. Diabetes is a well-established risk factor for pancreatic cancer.  A recent meta-analysis demonstrated that the risk of pancreatic cancer was double in patients with type-1 diabetes compared to those without

Heavy alcohol consumption.  A recent meta-analysis found that low and moderate alcohol consumption was not associated with pancreatic cancer, however, those with a high alcohol consumption had a 15% increased risk

Obesity. Given the strength of the evidence linking obesity to pancreatic cancer, it is likely that the rising incidence of obesity is a major factor for the increasing incidence of pancreatic cancer in the developed world. 

Diagnosis and treatment

Pancreatic cancer may present with jaundice, abdominal pain, unexplained fatigue, weight loss, loss of appetite, tea-colored urine and light colored stool. The diagnostic approach includes imaging with CT, MRI-MRCP, endoscopic ultrasound and ERCP with tissue sampling and tumor markers. The CA 19-9 tumor marker may be elevated in pancreatic cancer. However, it may be high in many other conditions, benign or malignant, so it is serves as an adjunct to the diagnosis and not a prerequisite.

The gastroenterologist plays a crucial part in the diagnosis and therapy of pancreatic cancer. With the use of endoscopic ultrasound (EUS) guided biopsy (FNA) tissue may be obtained for diagnosis. With the use of ERCP plastic or metal stents may be placed in the bile ducts to relieve jaundice and to facilitate recovery.

The definitive treatment of pancreatic cancer is surgery, usually Whipple surgery, total or distal pancreatectomy, as well as chemotherapy and radiation. Unfortunately, surgery cannot be applied in all cases.

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