Pancreatic Cancer

  • Jennifer S. Yu
  • Joy Coleman
  • Jeanne Marie Quivey


Fifth leading cause of cancer mortality, although only the ninth most common cancer. Found primarily in Western countries. Known risks include tobacco use, diets high in animal fat, ionizing radiation, chemotherapy, and exposure to 2-naphthylamine, benzene, and gasoline. Possible links between alcohol use, coffee use, chronic pancreatitis, and diabetes are less clear. Four parts: head (including uncinate process), neck, body, and tail. Two-third cancers present in the head. Most common presenting symptoms = jaundice (due to common bile duct obstruction), weight loss (due to malabsorption from pancreas exocrine dysfunction), diabetes (related to pancreas endocrine dysfunction), gastric outlet obstruction, and abdominal pain. Jaundice is most common in patients with lesions in the head. Patients with lesions arising in the body or tail typically present with midepigastric or back pain. May infrequently present with Trousseau’s sign (migratory thrombophlebitis) or Courvoisier’s sign (palpable gallbladder).Primary LN drainage includes the pancreaticoduodenal, suprapancreatic, pyloric, and pancreaticosplenic LN with the porta hepatic, infrapyloric, subpyloric, celiac, superior mesenteric, and paraaortic areas being involved in advanced disease. Most common type is of ductal origin. Cystadenocarcinomas, intraductal carcinomas, and solid and cystic papillary neoplasms (also known as Hamoundi tumors) have a more indolent course. Acinar cell cancers and giant cell tumors are aggressive and have poor survival. Five percent are tumors of the endocrine pancreas – these tumors are rare, slow growing, and have a long natural history.Seventy to hundred percent contain k-ras oncogene. TP53 mutation present in approximately 50%. Peritoneal and liver mets are most common. Lung is most common location outside the abdomen Postresection CA19-9 levels prognostic in patients treated with chemorad per RTOG 9704 (Berger et al. 2008).


Pancreatic Cancer Giant Cell Tumor Gastric Outlet Obstruction Common Bile Duct Obstruction Positive Regional Node 
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Further Reading

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Copyright information

© Springer-Verlag New York 2010

Authors and Affiliations

  • Jennifer S. Yu
    • 1
  • Joy Coleman
    • 2
  • Jeanne Marie Quivey
    • 1
  1. 1.Radiation OncologyUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Radiation OncologyElmhurst Memorial HospitalElmhurstUSA

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