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| {{Infobox_Disease| | | __NOTOC__ |
| Name = Pancreatic cancer |
| | {{Pancreatic cancer}} |
| Image = Illu pancrease.jpg |
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| Caption = |
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| DiseasesDB = 9510 |
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| ICD10 = {{ICD10|C|25||c|15}} |
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| ICD9 = {{ICD9|157}} |
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| ICDO = |
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| OMIM = 260350 |
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| MedlinePlus = 000236 |
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| eMedicineSubj = med |
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| eMedicineTopic = 1712 |
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| MeshID = D010190 |
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| }}
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| {{SI}}
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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| | {{CMG}}; {{AE}} {{Cherry}} {{ARK}} |
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| {{CMG}} | | {{SK}} Carcinoma of pancreas |
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| '''Associate Editor-In-Chief:''' {{CZ}}
| | ==[[Pancreatic cancer overview|Overview]]== |
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| {{EH}}
| | ==[[Pancreatic cancer historical perspective|Historical Perspective]]== |
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| ==Overview== | | ==[[Pancreatic cancer classification|Classification]]== |
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| '''Pancreatic cancer''' is a [[cancer|malignant tumour]] within the [[pancreas|pancreatic gland]]. Each year about 33,000 individuals in the United States are diagnosed with this condition, and more than 60,000 in Europe. Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with few victims still alive five years after diagnosis, and complete [[remission (medicine)|remission]] still extremely rare.<ref name=Ghaneh>{{cite journal |author=Ghaneh P, Costello E, Neoptolemos JP |title=Biology and management of pancreatic cancer |journal=Gut |volume=56 |issue=8 |pages=1134-52 |year=2007 |pmid=17625148 |doi=10.1136/gut.2006.103333}}</ref>
| | ==[[Pancreatic cancer pathophysiology|Pathophysiology]]== |
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| About 95 percent of pancreatic tumors are [[adenocarcinoma]]s ({{ICDO|8140|3}}). The remaining 5 percent include other tumors of the exocrine pancreas (e.g. serous cystadenomas), acinar cell cancers, and pancreatic [[neuroendocrine tumor]]s (such as [[insulinoma]]s, {{ICDO|8150|1}}, {{ICDO|8150|3}}). These tumors have a completely different diagnostic and therapeutic profile, and generally a more favorable prognosis.<ref name=Ghaneh/>
| | ==[[Pancreatic cancer causes|Causes]]== |
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| ==Signs and symptoms== | | ==[[Pancreatic cancer differential diagnosis|Differentiating Pancreatic Cancer from other Disorders]]== |
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| ===Presentation=== | | ==[[Pancreatic cancer epidemiology and demographics|Epidemiology and Demographics]]== |
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| Early diagnosis of pancreatic cancer is difficult because the symptoms are so non-specific and varied. Common symptoms include [[abdominal pain|pain in the upper abdomen]] that typically radiates to the back and is relieved by leaning forward (seen in carcinoma of the body or tail of the pancreas), [[loss of appetite]], significant [[weight loss]] and painless [[jaundice]] related to [[bile duct]] obstruction (carcinoma of the head of the pancreas). All of these symptoms can have multiple other causes. Therefore, pancreatic cancer is often not diagnosed until it is advanced.
| | ==[[Pancreatic cancer risk factors|Risk Factors]]== |
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| [[Jaundice]] occurs when the tumor grows and 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) are more likely to cause jaundice by this mechanism. | | ==[[Pancreatic cancer screening|Screening]]== |
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| [[Trousseau's sign of malignancy|Trousseau's sign]], in which blood clots form spontaneously in the [[portal venous system|portal blood vessels]], the deep veins of the extremities, or the superficial veins anywhere on the body, is sometimes associated with pancreatic cancer.
| | ==[[Pancreatic cancer natural history|Natural History, Complications and Prognosis]]== |
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| [[Clinical depression]] has been reported in association with pancreatic cancer, sometimes presenting before the cancer is diagnosed. However, the mechanism for this association is not known.<ref>Carney CP, Jones L, Woolson RF, Noyes R Jr, Doebbeling BN. Relationship between depression and pancreatic cancer in the general population. ''Psychosom Med'' 2003;65:884-8. PMID 14508036.</ref>.
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| ===Predisposing factors=== | |
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| Risk factors for pancreatic cancer include:<ref>http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_pancreatic_cancer_34.asp?sitearea=</ref>
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| *Age
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| *Male gender
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| *African ethnicity
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| *[[Tobacco smoking|Smoking]]
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| *Diets high in meat
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| *[[Obesity]]
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| *[[Diabetes]]
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| *[[Chronic pancreatitis]] has been linked, but is not known to be causal.
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| *Occupational exposure to certain [[pesticide]]s, [[dye]]s, and chemicals related to gasoline
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| *Family history, including [[autosomal recessive]] [[ataxia-telangiectasia]] and autosomal dominantly inherited mutations in the [[BRCA2]] [[gene]], [[Peutz-Jeghers syndrome]] due to mutations in the STK11 tumor suppressor gene, [[hereditary non-polyposis colon cancer]] (Lynch syndrome), familial adenomatous polyposis, and the familial atypical multiple mole melanoma-pancreatic cancer syndrome (FAMMM-PC) due to mutations in the ''[[CDKN2A]]'' tumor suppressor gene.<ref>{{cite journal |author=Efthimiou E, Crnogorac-Jurcevic T, Lemoine NR, Brentnall TA |year=2001 |month=Feb |title=Inherited predisposition to pancreatic cancer |journal=Gut |volume=48 |issue=2 |pages=143-7 |id=PMID 11156628 |url=}}</ref><ref name=Ghaneh/>
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| *''[[Helicobacter pylori]]'' infection
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| *Gingivitis or periodontal disease.<ref>{{cite journal |author=Michaud DS, Joshipura K, Giovannucci E, Fuchs CS |title=A prospective study of periodontal disease and pancreatic cancer in US male health professionals |journal=J. Natl. Cancer Inst. |volume=99 |issue=2 |pages=171-5 |year=2007 |pmid=17228001 |doi=10.1093/jnci/djk021}}</ref>
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| ====Alcohol====
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| It is controversial whether alcohol consumption is a risk factor for pancreatic cancer. Drinking alcohol excessively is a major cause of [[chronic pancreatitis]], which in turn predisposes to pancreatic cancer, but "chronic pancreatitis that is due to alcohol doesn't increase risk as much as other types of chronic pancreatitis.<ref name=cruk>[[Cancer Research UK]] [http://www.cancerhelp.org.uk/help/default.asp?page=3102#alcohol Pancreatic cancer risks and causes]</ref> Overall, the association is consistently weak and the majority of studies have found no association.<ref name=aa21>[[National Institute on Alcohol Abuse and Alcoholism]] [http://pubs.niaaa.nih.gov/publications/aa21.htm Alcohol and Cancer - Alcohol Alert No. 21-1993]</ref><ref>[[American Cancer Society]] [http://www.cancer.org/docroot/NWS/content/update/NWS_1_1xU_Coffee_and_Alcohol_Do_Not_Pose_a_Risk_for_Pancreatic_Cancer.asp Coffee and Alcohol Do Not Pose a Risk for Pancreatic Cancer]</ref><ref>Villeneuve PJ, Johnson KC, Hanley AJ, Mao Y [http://www.ncbi.nlm.nih.gov/pubmed/10777010 Alcohol, tobacco and coffee consumption and the risk of pancreatic cancer: results from the Canadian Enhanced Surveillance System case-control project. Canadian Cancer Registries Epidemiology Research Group] ''Eur J Cancer Prev'' 2000 Feb;9(1):49-58. PMID: 10777010</ref><ref name=Michaud/>
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| Some studies suggest a relationship,<ref>Ahlgren, J. D., ''et al''. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8623060&dopt=Abstract Epidemiology and risk factors in pancreatic cancer] ''Seminars in Oncology'', 1996, ''23(2)'', 241-250.</ref> with risk increasing with increasing amount of alcohol intake.<ref>Cuzick J, Babiker AG [http://www.ncbi.nlm.nih.gov/pubmed/2925272 Pancreatic cancer, alcohol, diabetes mellitus and gall-bladder disease] ''Int J Cancer'' 1989 Mar 15;43(3):415-21</ref><ref>Harnack LJ, Anderson KE, Zheng W, Folsom AR, Sellers TA, Kushi LH [http://www.ncbi.nlm.nih.gov/pubmed/9419407 Smoking, alcohol, coffee, and tea intake and incidence of cancer of the exocrine pancreas: the Iowa Women's Health Study] ''Cancer Epidemiol Biomarkers Prev'' 1997 Dec;6(12):1081-6 PMID: 9419407</ref> Risk is greatest in heavy drinkers<ref>Schottenfeld, D. and J. Fraumeni, ed. Cancer epidemiology and prevention. 2nd ed., ed. Vol. 1996, Oxford University Press: Oxford</ref><ref name=Ye>W Ye, J Lagergren, E Weiderpass, O Nyrén, H-O Adami, A Ekbom [http://gut.bmj.com/cgi/content/abstract/51/2/236 Alcohol abuse and the risk of pancreatic cancer] ''Gut'' 2002;51:236-239</ref><ref name=Silverman>Silverman DT, Brown LM, Hoover RN, Schiffman M, Lillemoe KD, Schoenberg JB, Swanson GM, Hayes RB, Greenberg RS, Benichou J, et al [http://www.ncbi.nlm.nih.gov/pubmed/7585527?dopt=Abstract Alcohol and pancreatic cancer in blacks and whites in the United States] ''Cancer Res'', 1995. 55(21): p. 4899-905. PMID: 7585527</ref> mostly on the order of four or more drinks per day.<ref>G W Olsen, J S Mandel, R W Gibson, L W Wattenberg and L M Schuman [http://www.ajph.org/cgi/reprint/79/8/1016 A case-control study of pancreatic cancer and cigarettes, alcohol, coffee and diet] ''American Journal of Public Health'' Vol. 79, Issue 8 1016–1019</ref> But there appears to be no increased risk for people consuming up to 30g of alcohol a day,<ref name=Michaud>Michaud DS, Giovannucci E, Willett WC, Colditz GA, Fuchs CS [http://www.ncbi.nlm.nih.gov/pubmed/11352851 Coffee and alcohol consumption and the risk of pancreatic cancer in two prospective United States cohorts] ''Cancer Epidemiol Biomarkers Prev'' 2001 May;10(5):429-37 PMID: 11352851</ref><ref>[http://info.cancerresearchuk.org/cancerstats/types/pancreas/riskfactors/ Pancreatic cancer risk factors]</ref> so most of the U.S. consumes alcohol at a level that "is probably not a risk factor for pancreatic cancer."<ref name=Silverman/>
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| Several studies caution that their findings could be due to confounding factors.<ref name=Ye/><ref>Zatonski WA, Boyle P, Przewozniak K, Maisonneuve P, Drosik K, Walker AM [http://www.ncbi.nlm.nih.gov/pubmed/8436433 Cigarette smoking, alcohol, tea and coffee consumption and pancreas cancer risk: a case-control study from Opole, Poland] ''Int J Cancer'' 1993 Feb 20;53(4):601-7 PMID: 8436433</ref> Even if a link exists, it "could be due to the contents of some alcoholic beverages"<ref>Durbec JP, Chevillotte G, Bidart JM, Berthezene P, Sarles H. [http://www.ncbi.nlm.nih.gov/pubmed/6849792 Diet, alcohol, tobacco and risk of cancer of the pancreas: a case-control study] ''Br J Cancer'' 1983 Apr;47(4):463-70.</ref> other than the alcohol itself. One Dutch study even found that drinkers of white wine had lower risk.<ref>Bueno de Mesquita HB, Maisonneuve P, Moerman CJ, Runia S, Boyle P. [http://www.ncbi.nlm.nih.gov/pubmed/1537615 Lifetime consumption of alcoholic beverages, tea and coffee and exocrine carcinoma of the pancreas: a population-based case-control study in The Netherlands] ''Int J Cancer'' 1992 Feb 20;50(4):514-22 PMID: 1537615</ref>
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| ==Diagnosis== | | ==Diagnosis== |
| | | [[Pancreatic cancer staging|Staging]] | [[Pancreatic cancer history and symptoms|History and Symptoms]] | [[Pancreatic cancer physical examination|Physical Examination]] | [[Pancreatic cancer laboratory tests|Laboratory Findings]] | [[Pancreatic cancer chest x ray|Chest X Ray]] | [[Pancreatic cancer CT|CT]] | [[Pancreatic cancer MRI|MRI]] | [[Pancreatic cancer ultrasound|Ultrasound]] | [[Pancreatic cancer other imaging findings|Other Imaging Findings]] | [[Pancreatic cancer other diagnostic studies|Other Diagnostic Studies]] |
| Most patients with pancreatic cancer experience pain, weight loss, or [[jaundice]].<ref name="pmid1589710">{{cite journal |author=Bakkevold KE, Arnesjø B, Kambestad B |title=Carcinoma of the pancreas and papilla of Vater: presenting symptoms, signs, and diagnosis related to stage and tumour site. A prospective multicentre trial in 472 patients. Norwegian Pancreatic Cancer Trial |journal=Scand. J. Gastroenterol. |volume=27 |issue=4 |pages=317–25 |year=1992 |pmid=1589710|doi=10.3109/00365529209000081 }}</ref>
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| Pain is present in 80 to 85 percent of patients with locally advanced or advanced metastic disease. The pain is usually felt in the upper abdomen as a dull ache that radiates straight through to the back. It may be intermittent and made worse by eating.
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| Weight loss can be profound; it can be associated with [[anorexia]], early [[satiety]], [[diarrhea]], or [[steatorrhea]].
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| [[Jaundice]] is often accompanied by [[Itch|pruritus]] and dark urine. Painful jaundice is present in approximately one-half of patients with locally unresectable disease, while painless jaundice is present in approximately one-half of patients with a potentially resectable and curable lesion.
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| The initial presentation varies according to location of the cancer. Malignancies in the pancreatic body or tail usually present with pain and weight loss, while those in the head of the gland typically present with steatorrhea, weight loss, and jaundice. The recent onset of atypical diabetes mellitus, a history of recent but unexplained [[thrombophlebitis]] ([[Trousseau's sign]]), or a previous attack of [[pancreatitis]] are sometimes noted.
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| [[Courvoisier's law|Courvoisier sign]] 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 [[gallstone]]s. | |
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| Tiredness, irritability and difficulty eating due to pain also exist. Pancreatic cancer is usually discovered during the course of the evaluation of aforementioned symptoms.
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| [[Liver function test]]s can show a combination of results indicative of bile duct obstruction (raised [[conjugated bilirubin]], [[Gamma glutamyl transpeptidase|γ-glutamyl transpeptidase]] and [[alkaline phosphatase]] levels). [[CA19-9]] (carbohydrate antigen 19.9) is a [[tumor marker]] that is frequently elevated in pancreatic cancer. However, it lacks sensitivity and specificity. When a cutoff above 37 U/mL is used, this marker has a sensitivity of 77% and specificity of 87% in discerning benign from malignant disease. CA 19-9 might be normal early in the course, and could be elevated due to benign causes of biliary obstruction.<ref>{{cite book |author=Frank J. Domino M.D.etc. |title=5 minutes clinical suite version 3 | year=2007 | publisher=Lippincott Williams & Wilkins | location=Philadelphia, PA}}</ref>
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| Imaging studies, such as [[computed tomography]] (CT scan) can be used to identify the location of the cancer. [[Endoscopic ultrasound]] (EUS) is another procedure that can help visualize the location and can serve to guide a percutaneous needle biopsy, which is necessary to establish a definitive diagnosis.<ref name=ACP>Philip, Philip Agop. "Pancreatic Cancer." ''ACP PIER & AHFX DI Essentials.'' American College of Physicians. 4 Apr 2008. Accessed 7 Apr 2009.</ref> | |
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| Recent research indicates that in pancreatic cancer [[Malignant|malignancies]], the tumor contains markedly higher levels of certain [[microRNA]]s (miRNA) than does the patient's [[benign]] pancreatic tissue or that found in other healthy pancreases. This paves the way for two possibilities:
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| 1) a more early but likely expensive genetic and biochemical molecular [[Screening (medicine)|screening]] test profile, which would be an innovation in this cancer;
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| 2) also possible new, creative and more effective therapies based on the various microRNA levels. This opens an exciting new front in confronting a very deadly disease.
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| As a summary; tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer as follow:
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| * Physical exam and history
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| * Tumor markers
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| * Chest x-ray
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| * CT scan (CAT scan)
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| * MRI (magnetic resonance imaging)
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| * PET scan (positron emission tomography scan)
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| * Endoscopic ultrasound (EUS): This procedure is also called endosonography.
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| * Laparoscopy
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| * Endoscopic retrograde cholangiopancreatography (ERCP)
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| * Percutaneous transhepatic cholangiography (PTC): This test is done only if ERCP cannot be done.
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| * Biopsy
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| ==Diagnostic Findings==
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| [http://www.radswiki.net Images courtesy of RadsWiki]
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| <gallery>
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| Image:Pancreatic adenocarcinoma 001.jpg|Pancreatic adenocarcinoma
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| Image:Pancreatic adenocarcinoma 002.jpg|Pancreatic adenocarcinoma
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| Image:Pancreatic adenocarcinoma 003.jpg|Pancreatic adenocarcinoma
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| </gallery>
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| ==Treatment== | | ==Treatment== |
| ===Surgery===
| | [[Pancreatic cancer medical therapy|Medical Therapy]] | [[Pancreatic cancer surgery|Surgery]] | [[Pancreatic cancer treatment by stage|Treatment by Stage]] | [[Pancreatic cancer primary prevention|Primary Prevention]] | [[Pancreatic cancer secondary prevention|Secondary Prevention]] | [[Pancreatic cancer cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pancreatic cancer future or investigational therapies|Future or Investigational Therapies]] |
| Treatment of pancreatic cancer depends on the stage of the cancer.<ref>[http://pathology.jhu.edu/pancreas/TreatmentSurgery.php Pancreatic Cancer - Johns Hopkins Medicine: Surgical Treatment of Pancreatic Cancer<!-- Bot generated title -->]</ref> The [[Pancreaticoduodenectomy|Whipple procedure]] is the most common surgical treatment for cancers involving the head of the pancreas. It can only be performed if the patient is likely to survive major surgery and if the cancer is localised without invading local structures or metastasizing. It can therefore only be performed in the minority of cases.
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| [[Spleen]]-preserving distal pancreatectomy can also be used as a method to remove a cancer running through centre of pancreas; this is invasive surgery, resulting in loss of body and tail. Cancers of the tail of the pancreas can be resected using a procedure known as a distal pancreatectomy.<ref>Retrieved from http://pathology.jhu.edu/pancreas/TreatmentSurgery.php.</ref> Recently, localized cancers of the pancreas have been resected using minimally invasive (laparoscopic) approaches.<ref name=ACP/> | |
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| After surgery, ''adjuvant'' chemotherapy with [[gemcitabine]] may be offered to eliminate whatever cancerous tissue may remain in the body. This has been shown to increase 5-year survival rates. Addition of [[radiation therapy]] is a hotly debated topic, with groups in the US often favoring the use of adjuvant radiation therapy, while groups in Europe do not.<ref name="pmid15028824">{{cite journal |author=Neoptolemos JP, Stocken DD, Friess H, ''et al'' |title=A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer |journal=N. Engl. J. Med. |volume=350 |issue=12 |pages=1200–10 |year=2004 |pmid=15028824 |doi=10.1056/NEJMoa032295}}</ref>
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| Surgery can be performed for palliation, if the malignancy is invading or compressing the [[duodenum]] or [[colon (anatomy)|colon]]. In that case, bypass surgery might overcome the obstruction and improve quality of life, but it is not intended as a cure.<ref name=ACP/> | |
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| Criteria for unresectability:
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| * Tumor larger than 5 cm
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| * Tumor invades adjacent tissue of organs (excluding duodenum)
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| * Encasement, stenosis, or occlusion of the celiac artery, celiac artery branches, and/or SMA.
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| * ''PV and/or SMV encasement (some centers will operate with venous invasion)''
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| * Hepatic metastases
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| * Distant metastases (i.e. non regional lymph nodes)
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| * Peritoneal carcinomatosis
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| ===Chemotherapy===
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| In patients not suitable for resection with curative intent, palliative [[chemotherapy]] may be used to improve quality of life and gain a modest survival benefit. [[Gemcitabine]] was approved by the US [[FDA]] in 1998 after a clinical trial reported improvements in [[quality of life]] in patients with advanced pancreatic cancer. This marked the first FDA approval of a chemotherapy drug for a non-survival [[clinical trial]] endpoint. Gemcitabine is administered intravenously on a weekly basis. Addition of [[oxaliplatin]] (Gem/Ox) conferred benefit in small trials, but is not yet standard therapy.<ref name="pmid16434988">{{cite journal |author=Demols A, Peeters M, Polus M, ''et al'' |title=Gemcitabine and oxaliplatin (GEMOX) in gemcitabine refractory advanced pancreatic adenocarcinoma: a phase II study |journal=Br. J. Cancer |volume=94 |issue=4 |pages=481–5 |year=2006 |pmid=16434988 |doi=10.1038/sj.bjc.6602966}}</ref> [[Fluorouracil]] (5FU) may also be included.
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| On the basis 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 regimen for pancreatic cancer. This trial compared the action of gemcitabine/erlotinib vs gemcitabine/placebo and demonstrated improved survival rates, improved tumor response and improved progression-free survival rates. The survival improvement with the combination is on the order of less than four weeks, leading some [[cancer]] experts to question the incremental value of adding [[erlotinib]] to [[gemcitabine]] treatment. New trials are now investigating the effect of the above combination in the adjuvant and neoadjuvant setting.<ref>[http://www.fda.gov/ohrms/dockets/AC/05/briefing/2005-4174B1_03_01-OSI-Tarceva.pdf#search=%22%20fda%20erlotinib%20pancreatic%22 FDA approval briefing]</ref> A trial of anti-angiogenesis agent [[bevacizumab]] (Avastin) as an addition to chemotherapy has shown no improvement in survival of patients with advanced pancreatic cancer. It may cause higher rates of high blood pressure, bleeding in the stomach and intestine, and intestinal perforations.
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| ===Nutritional supplements===
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| A phase II clinical trial studying the effect of [[curcumin]] on pancreatic cancer was completed in 2007 and the results were published in 2008. The study used eight grams per day in 21 patients and stopped treatment if the tumor size increased. The conclusion of the study was "Oral curcumin is well tolerated and, despite its limited absorption, has biological activity in some patients with pancreatic cancer."<ref>{{cite journal |author=Dhillon N, Aggarwal BB, Newman RA, ''et al'' |title=Phase II trial of curcumin in patients with advanced pancreatic cancer |journal=Clin. Cancer Res. |volume=14 |issue=14 |pages=4491–9 |year=2008 |month=July |pmid=18628464 |doi=10.1158/1078-0432.CCR-08-0024 |url=}}</ref><ref>{{cite web |author=De Leon D |url=http://www.cancerwise.org/September_2008/print.cfm?id=D1F9875B-28E5-4CC2-89D07EE517C4F03B&method=DisplayFull |title=Cancer News and Information: Curcumin Temporarily Slows Pancreatic Cancer |format= |work=CancerWise |accessdate=}}</ref>
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| ==Treatment Options by Stage==
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| ===Stages I and II Pancreatic Cancer===
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| Treatment of stage I and stage II pancreatic cancer may include the following:
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| * Surgery alone.
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| * Surgery with chemotherapy and radiation therapy.
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| ===Stage III Pancreatic Cancer===
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| Treatment of stage III pancreatic cancer may include the following:
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| * Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.
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| * Chemotherapy with gemcitabine.
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| ===Stage IV Pancreatic Cancer=== | | ==Case Studies== |
| | [[Pancreatic cancer case study one|Case #1]] |
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| Treatment of stage IV pancreatic cancer may include the following:
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| * Chemotherapy with gemcitabine with or without erlotinib.
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| * Palliative treatments for pain, such as nerve blocks, and other supportive care.
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| * Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.
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| ===Treatment Options for Recurrent Pancreatic Cancer===
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| Treatment of recurrent pancreatic cancer may include the following:
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| * Chemotherapy.
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| * Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.
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| * Palliative radiation therapy.
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| * Other palliative medical care to reduce symptoms, such as nerve blocks to relieve pain.
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| ==Prognosis==
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| Patients diagnosed with pancreatic cancer typically have a poor [[prognosis]] partly 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%<ref>http://www.who.int/tobacco/research/cancer/en/</ref> With 32,180 new diagnoses in the United States every year, and 31,800 deaths, mortality approaches 99%, giving pancreatic cancer the highest fatality rate of all cancers and the fourth highest cancer killer in the United States amongst both men and women.<ref>http://pancan.org/About/pancreaticCancerStats.html</ref>
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| Pancreatic cancer occasionally may result in [[Diabetes mellitus|diabetes]]. Insulin production is hampered and it has been suggested that the cancer can also prompt the onset of diabetes and vice versa.<ref>http://www.molecular-cancer.com/content/2/1/4</ref>
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| ==Prevention==
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| Prevention of pancreatic cancer consists of avoiding risk factors when possible<ref>http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_pancreatic_cancer_be_prevented_34.asp?rnav=cri</ref> [[Tobacco smoking|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.
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| The [[American Cancer Society]] recommends increasing consumption of fruits, vegetables, and whole grains while decreasing red meat intake. This has been questioned by several research groups.<ref> {{cite journal|title=Predictors of pancreatic cancer mortality among a large cohort of United States adults.|journal=Cancer Causes Control. |date=2000 Dec|first=SS|last=Coughlin |coauthors=Calle EE, Patel AV, Thun MJ.|volume=11|issue=10|pages=915-23.|id=PMID 11142526 |url=|format=|accessdate=2007-02-27}}</ref><ref> {{cite journal|title=A cohort study of smoking, alcohol consumption, and dietary factors for pancreatic cancer (United States).|journal=Cancer Causes Control. |date=1993 Sep|first=W|last=Zheng |coauthors=et al|volume=4|issue=5|pages=477-82. |id=PMID 8218880 |url=|format=|accessdate=2007-02-27}}</ref>
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| In 2006 a large prospective cohort study of over 80,000 subjects failed to prove a definite association.<ref> {{cite journal|title=Fruit and vegetable consumption in relation to pancreatic cancer risk: a prospective study.|journal=Cancer Epidemiology Biomarkers & Prevention|date=February 2006|first=Susanna|last=Larsson|coauthors=Niclas Håkansson, Ingmar Näslund, Leif Bergkvist and Alicja Wolk|volume=15|issue=|pages=301-305|id=PMID 16492919 |url=|format=|accessdate=2007-02-27}}</ref> The evidence in support of this lies mostly in small case-control studies.
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| 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%.<ref>http://news.bbc.co.uk/1/hi/health/5334534.stm</ref><ref>http://www.webmd.com/content/article/127/116673.htm</ref><ref>http://www.forbes.com/forbeslife/health/feeds/hscout/2006/09/14/hscout534925.html</ref> More studies of this have been called for.
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| Several studies, including one published June 1, 2007, indicate that B vitamins such as [[B12]], [[Vitamin B6|B6]], and [[folate]], can reduce the risk of pancreatic cancer when consumed in food, but not when ingested in vitamin tablet form.<ref>{{cite web |url=http://cancerres.aacrjournals.org/cgi/content/abstract/67/11/5553 |title=Plasma Folate, Vitamin B6, Vitamin B12, and Homocysteine and Pancreatic Cancer Risk in Four Large Cohorts -- Schernhammer et al. 67 (11): 5553 -- Cancer Research |accessdate=2007-06-04 |format= |work=}}</ref><ref>{{cite web |url=http://www.upi.com/Consumer_Health_Daily/Briefing/2007/06/01/pancreatic_cancer_risk_cut_by_b6_b12/3712/ |title=United Press International - Consumer Health Daily - Briefing |accessdate=2007-06-04 |format= |work=}}</ref>
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| ==Awareness==
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|
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| *November is Pancreatic Cancer Awareness ribbon|Awareness Month
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| *Purple is the traditional color chosen to represent pancreatic cancer awareness.
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| *The National Cancer Institute’s cancer research budget was $4.824 billion in 2004, an estimated $52.7 million of which was devoted to pancreatic cancer.<ref>http://pancan.org/About/pancreaticCancerStats.html</ref>
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| *Research spending per pancreatic cancer patient is $1145, the lowest of any leading cancer.<ref>http://pancan.org/About/pancreaticCancerStats.html</ref>
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| *For a list of celebrities who have succumbed to this disease, see
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| *The Pancreatic Cancer Action Network (PanCAN) was created as an advocacy group for pancreatic cancer.
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| *The national charity Pancreatic Cancer UK works to raise awareness in the UK
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| ==External links==
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| * [http://www.bidmc.org/YourHealth/ConditionsAZ.aspx?ChunkID=11635 Beth Israel Deaconess Medical Center: Pancreatic cancer]
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| * [http://goldminer.arrs.org/search.php?query=Pancreatic%20adenocarcinoma Goldminer: Pancreatic adenocarcinoma]
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| * [http://www.pancan.org/ Pancreatic Cancer Action Network (PanCAN)]
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| * [http://www.pancsoc.org.uk/ The Pancreatic Society of Great Britain and Ireland]
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| * [http://pathology.jhu.edu/pancreas/ The Johns Hopkins Pancreatic Cancer Web Site]
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| * [http://survivor-support.rare-cancer.org/forum/ Rare Pancreatic & Neuroendocrine Cancer Support]
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| * [http://www.pancreaticcancer.org.uk Pancreatic Cancer UK]
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| * [http://www.pancreatica.org/ Confronting Pancreatic Cancer] (Pancreatica.org)
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| * [http://www.cancersupportivecare.com/pancreas.html Cancer of the Pancreas] (Cancer Supportive Care Program)
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| * [http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=34 American Cancer Society: Detailed Guide on Pancreatic Cancer]
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| * [http://pathology2.jhu.edu/pancreas/nfptr.cfm The National Familial Pancreas Tumor Registry]
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| * [http://www.pccrproject.com/ Pancreatic Cancer Collaborative Registry (PCCR)]
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| * [http://www.lustgarten.org/LUS/CDA/HomePage.jsp The Lustgarten Foundation For Pancreatic Cancer Research]
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| ==References==
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| {{reflist|2}}
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| {{Gastroenterology}}
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| {{Tumors}}
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| {{SIB}}
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| [[Category:Types of cancer]]
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| [[Category:Oncology]]
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| [[da:Pancreascancer]]
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| [[de:Pankreastumor]]
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| [[es:Cáncer de páncreas]] | | [[es:Cáncer de páncreas]] |
| [[eo:Pankreata karcinomo]]
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| [[fr:Cancer du pancréas]] | | [[fr:Cancer du pancréas]] |
| [[ko:췌장암]]
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| [[it:Cancro del pancreas]]
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| [[he:סרטן הלבלב]]
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| [[lt:Kasos vėžys]]
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| [[nl:Alvleesklierkanker]]
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| [[ja:膵癌]] | | [[ja:膵癌]] |
| [[no:Bukspyttkjertelkreft]]
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| [[pl:Rak trzustki]] | | [[pl:Rak trzustki]] |
| [[pt:Câncer pancreático]] | | [[pt:Câncer pancreático]] |
| [[fi:Haimasyöpä]]
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| [[sv:Pankreascancer]]
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| [[tr:Pankreas kanseri]] | | [[tr:Pankreas kanseri]] |
| [[zh:胰腺癌]] | | [[zh:胰腺癌]] |
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| | [[Category:Disease]] |
| | [[Category:Types of cancer]] |
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| | [[Category:Mature chapter]] |
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| | [[Category:Oncology]] |
| | [[Category:Medicine]] |
| | [[Category:Surgery]] |
| | [[Category:Gastroenterology]] |