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).
KeywordsPancreatic Cancer Giant Cell Tumor Gastric Outlet Obstruction Common Bile Duct Obstruction Positive Regional Node
- Ann Surg Oncol. 2010 (epub ahead of print so no page numbers yet)Google Scholar
- GITSG, Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Gastrointestinal Tumor Study Group. Cancer 1987;59(12):2006-2010.Google Scholar
- Herman JM, Swartz MJ, Hsu CC, et al. Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: results of a large, prospectively collected database at the Johns Hopkins Hospital. J Clin Oncol 2008;26(21):3503-3510.PubMedCrossRefGoogle Scholar
- Hsu CC, Herman JM, Corsini MM, et al. Adjuvant chemoradiation for pancreatic adenocarcinoma: The Johns Hopkins Hospital-Mayo Clinic collaborative study.Google Scholar
- Klinkenbijl JH, Jeekel J, Sahmoud T, et al. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 1999;230(6):776-782; discussion 782-784.Google Scholar
- Moertel CG, Frytak S, Hahn RG, et al. Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil: The Gastrointestinal Tumor Study Group. Cancer 1981;48(8):1705-1710.PubMedCrossRefGoogle Scholar
- Neoptolemos JP, Stocken DD, Friess H, et al. MW; European Study Group for Pancreatic Cancer. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004;350(12):1200-1210. Erratum in: N Engl J Med 2004; 351(7):726.Google Scholar
- Picozzi VJ, Abrams RA, Traverso LW, et al. ACOSOG Z05031: Initial report of a multicenter, phase II trial of a novel chemoradiation protocol using cistplatin, 5-FU, and alpha-interferon as adjuvant therapy for resected pancreatic cancer. ASCO 2008 Gastrointestical Cancers Symposium, abstract 125.Google Scholar
- Stessin AM, Meyer JE, and Sherr DL. Neoadjuvant radiation is associated with improved survival in patients with resectable pancreatic cancer: an analysis of data from the surveillance, epidemiology, and end results (SEER) registry. Int J Radiat Oncol Biol Phys 2008;72(4):1128-1133.PubMedCrossRefGoogle Scholar
- Tempero M, Plunkett W, Ruiz Van Haperen V, et al. Randomized phase II comparison of dose-intense gemcitabine: thirty-minute infusion and fixed dose rate infusion in patients with pancreatic adenocarcinoma. J Clin Oncol 2003;21(18):3402-3408.Google Scholar
- Abrams R. Primary Malignancies of the Pancreas, Periampullary Region and Hepatobiliary Tract – Considerations for the Radiation Oncologist (no. 310). Presented at the American Society of Therapeutic Radiology and Oncology Annual Meeting, San Francisco, CA; 2001.Google Scholar
- American Society of Therapeutic Radiology and Oncology. Active Protocols. http://www.rtog.org/members/protocols/97-04/97-04.pdf and http://www.rtog.org/members/protocols/98-12/98-12.pdf. Accessed February, 2005.
- Crane CH, Evans DB, Wolff RA, Abbruzzese JL, Pisters PWT, Janjan NA. The Pancreas. In: Cox JD, Ang KK, editors. Radiation oncology: rationale, technique, results. 8th ed. St. Louis: Mosby; 2003. pp. 465-480.Google Scholar
- Lillis-Hearne P. Cancer of the Pancreas. In: Leibel SA, Phillips TL, editors. Textbook of Radiation Oncology. 2nd ed. Philadelphia: Saunders; 2004. pp. 837-856.Google Scholar
- NCCN Physician Guidelines. Available at http://www.nccn.org/professionals/physician_gls/PDF/pancreatic.pdf. Accessed May 7, 2009.