Pancreas Cancer

Pancreatic cancer (also called cancer of the pancreas) is a malignant tumour within the pancreatic gland. Each year about 32,180 individuals in the United States are diagnosed with this condition, and more than 60,000 in Europe. Depending on the extent of the tumour at the time of diagnosis, the prognosis is generally regarded as poor, with few victims still alive 5 years after diagnosis, and complete remission still extremely rare.

About 95 percent of pancreatic tumors are adenocarcinomas (M8140/3). The remaining 5 percent, pancreatic neuroendocrine tumors have a completely different diagnostic and therapeutic profile, and generally a more favorable prognosis.

Early diagnosis of pancreatic cancer is difficult because the symptoms are so non-specific and varied. Common symptoms include abdominal pain, loss of appetite, significant weight loss and painless jaundice. All of these symptoms can be blamed on other causes. Therefore, diagnosis of pancreatic cancer is often late-stage in its development.

Jaundice occurs when the tumour grows and pressure obstructs the common bile duct, which runs partially through the head of the pancreas. Tumours of the head of the pancreas (approximately 60% of cases) will more easily give rise to such symptoms

Diagnosis

Courvoisier's law defines the presence of jaundice and a painlessly distended gallbladder as strongly indicative of pancreatic cancer, and may be used to distinguish pancreatic cancer from gallstones.

Pancreatic cancer is usually discovered during the course of the evaluation of aforementioned symptoms. Liver function tests may show a combination of results indicative of bile duct obstruction (raised bilirubin, γ-glutamyl transpeptidase and alkaline phosphatase levels). Imaging studies, such as ultrasound or abdominal CT may be used to identify tumors. Endoscopic ultrasound  is another procedure that can help visualize the tumor and obtain tissue to establish the diagnosis.

Treatment

Treatment of pancreatic cancer depends on the stage of the cancer [3] Recent advances have made resection (surgical removal) of tumors that were previously unresectable due to blood vessel involvement possible. The Whipple procedure is the most common surgical treatment for cancers involving the head of the pancreas.

For number of years, treatment of pancreatic cancer was limited to 5-fluorouracil (5-FU) alone. Then gemcitabine was introduced. Gemcitabine had no survival advantage in pancreatic cancer compared to 5-FU, but the drug was FDA approved for pancreatic cancer based on better improvement in symptoms compared to 5-FU.

Targeted therapy using several new drugs[4] is showing significant improvements in the treatment of pancreatic cancer. New drugs for the treatment of pancreatic cancer include: erlotinib, cetuximab, bevacizumab, tipifarnib. These drugs hold promise for the future treatment of patients with pancreatic cancer.

On the back of the results of a Canadian led Phase III Randomised Controlled trial involving 569 patients with advanced pancreatic cancer, the US FDA has licensed the use of erlotinib (Tarceva) in combination with gemcitabine as a palliative agent for this tumour. This trial compared the action of gemcitabine/erlotinib vs gemcitabine/placebo and demonstrated improved survival rates, improved tumour response and improved progression free survival rates. New trials are now investigating the effect of the above combination in the adjuvant and neoadjuvant setting a new vaccine had been developed to fight pancreatic cancer, with testing on human patients showing promising results

Prognosis

Patients diagnosed with pancreatic cancer typically have a poor prognosis because the cancer usually causes no symptoms early on, leading to metastatic disease at time of diagnosis. Median survival from diagnosis is around 3 to 6 months; 5-year survival is much less than 5% [7]. With 32,180 new diagnoses in the United States every year, and 31,800 deaths, mortality approaches 99%, giving pancreatic cancer the #1 fatality rate of all cancers and the #4 cancer killer in the United States amongst both men and women.

Pancreatic cancer occasionally may result in diabetes. The insulin production is hampered and it has been suggested that the cancer can also prompt the onset of diabetes and vice versa.

Prevention

Prevention of pancreatic cancer consists of avoiding risk factors when possible . Cigarette smoking is considered to be the most significant and avoidable risk factor for pancreatic cancer. Maintaining a healthy weight and exercising may be helpful. Additionally, increasing consumption of fruits, vegetables, and whole grains while decreasing red meat intake is recommended.

In September 2006, a long term study concluded that taking Vitamin D can substantially cut the risk of pancreatic cancer (as well as other cancers) by up to 50%.