The pancreas is an organ of the digestive and endocrine system located in the abdominal cavity behind the stomach. It helps to regulate several important hormones in the blood including insulin, glucagon, and somatostatin, and aids in digestion of carbohydrates, proteins, and lipids.
Pancreatic cancer is a highly lethal disease, for which mortality closely parallels incidence. It is one of the leading causes of cancer mortality in developed countries and one of the most lethal malignant neoplasms across the world.
Based on WHO estimates, pancreatic cancer causes more than 430,000 deaths each year, accounting for 4.5% of all cancer deaths. It ranks as the seventh most common cause of cancer death. Rates of death are greater in high-income countries.
Diagram of a pancreas.
To date, the causes of pancreatic cancer are still insufficiently known, although certain risk factors have been identified which include smoking, obesity, advanced age, pancreatitis, heavy alcohol drinking, genetics, and diet (Bosetti, Mol Carcinog, 2012).
Part of the reason pancreatic cancer is so lethal is because most patients remain asymptomatic until the disease reaches an advanced stage. When patients do present with symptoms they include weight loss, abdominal pain, jaundice, nausea and vomiting, back pain, and lethargy.
The initial presentation of pancreatic cancer varies according to the tumor location. Tumors at the pancreatic head present more often with jaundice, steatorrhea, and weight loss compared to tumors of the body and tail (Keane, BMJ Open, 2014; Porta, Clin Transl Oncol, 2005). There is no standard screening protocols for patients, making the disease even more difficult to detect (Kamisawa, Lancet, 2016).
The two main tumor types of pancreatic cancer are ductal adenocarcinoma, accounting for about 85% of cases, and pancreatic endocrine tumors, which make up less than 5% of all cases (Ilic, World J Gastroenterol, 2016).
If pancreatic cancer is suspected, patients receive a full lab workup, including an analysis of liver, gallbladder, and pancreatic function. If a pancreatic mass is seen on initial imaging, an abdominal computed tomography (CT) is obtained to confirm the presence of the mass and assess disease extent.
Treatment of pancreatic cancer includes surgery, chemotherapy, radiation therapy, and palliative care. Surgical resection is regarded as the only potentially curative treatment for pancreatic adenocarcinoma, however, because of the late presentation of the disease, only 15-20% of patients are candidates for pancreatectomy.
Despite surgical and medical advancements, the life expectancy for pancreatic cancer patients has seen no substantial changes in the past 40 years. Palliative treatment is often the only available option for patients (Ferro, Nature, 2018). There is an unmet need for more effective treatment strategies to improve prognosis.