Pancreatic cancer natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
The symptoms of [[pancreatic cancer]] usually develop in the sixth decade of life, and start with symptoms such as [[jaundice]], [[Acholic stools|light-colored stools]], [[Urine|dark urine]], pain in the upper or middle [[abdomen]] and back, unexplained [[weight loss]], anorexia and [[fatigue]].Symptoms typically develop about 20-30 years after exposure to risk factors such as [[smoking]] and [[alcohol]]. Genetic factors such as alterations in [[Tumor suppressor gene|tumor suppressor genes]], [[Oncogene|oncogenes]] and different signaling pathways are responsible. If left untreated, patients with [[pancreatic cancer]] may progress to develop [[Exocrine gland|exocrine]] [[pancreatic insufficiency]] arising from [[pancreatic duct]] [[obstruction]] leading to [[malabsorption]], [[malnutrition]] and [[cachexia]]. Dudodenal [[obstruction]] and [[Bile duct|biliary]] [[obstruction]] may cause symptoms of [[bowel obstruction]] and [[jaundice]]. Common complications of [[pancreatic cancer]] may arise as a result of the [[disease]] or [[therapy]] (surgical or [[Medicine|medical]]). Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with complete [[remission (medicine)|remission]] extremely rare.
The symptoms of [[pancreatic cancer]] usually develop in the sixth decade of life, and start with symptoms such as [[jaundice]], [[Acholic stools|light-colored stools]], [[Urine|dark urine]], pain in the upper or middle [[abdomen]] and back, unexplained [[weight loss]], anorexia and [[fatigue]].Symptoms typically develop about 20-30 years after exposure to [[Risk factor|risk factors]] such as [[smoking]] and [[alcohol]]. [[Genetic|Genetic factors]] such as alterations in [[Tumor suppressor gene|tumor suppressor genes]], [[Oncogene|oncogenes]] and different [[Signal transduction|signaling pathways]] are responsible. If left untreated, patients with [[pancreatic cancer]] may progress to develop [[Exocrine gland|exocrine]] [[pancreatic insufficiency]] arising from [[pancreatic duct]] [[obstruction]] leading to [[malabsorption]], [[malnutrition]] and [[cachexia]]. Dudodenal [[obstruction]] and [[Bile duct|biliary]] [[obstruction]] may cause symptoms of [[bowel obstruction]] and [[jaundice]]. Common complications of [[pancreatic cancer]] may arise as a result of the [[disease]] or [[therapy]] (surgical or [[Medicine|medical]]). Depending on the extent of the [[tumor]] at the time of [[diagnosis]], the [[prognosis]] is generally regarded as poor, with complete [[remission (medicine)|remission]] extremely rare.


==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
The symptoms of [[pancreatic cancer]] usually develop in the sixth decade of life, and start with symptoms such as [[jaundice]], light-colored stools, [[Urine|dark urine]], pain in the upper or middle [[abdomen]] and back, unexplained [[weight loss]], [[anorexia]] and [[fatigue]]. Common complications of [[pancreatic cancer]] may arise as a result of the [[disease]] or [[therapy]] and include malabsorption, pain, jaundice and symptoms of bowel obstruction. Prognosis is found to be better in patients treated with surgery, as opposed to other patients.
The symptoms of [[pancreatic cancer]] usually develop in the sixth decade of life, and start with symptoms such as [[jaundice]], [[Acholic stools|light-colored stools]], [[Urine|dark urine]], [[pain]] in the upper or middle [[abdomen]] and back, unexplained [[weight loss]], [[anorexia]] and [[fatigue]]. Common [[Complication (medicine)|complications]] of [[pancreatic cancer]] may arise as a result of the [[disease]] or [[therapy]] and include [[malabsorption]], [[pain]], [[jaundice]] and symptoms of [[bowel obstruction]]. Prognosis is found to be better in patients treated with [[surgery]], as opposed to other patients.


==Natural History==
==Natural History==
The natural history of pancreatic cancer is as follows:<ref name="pmid27931833">{{cite journal |vauthors=Chang SC, Yang WV |title=Hyperglycemia, tumorigenesis, and chronic inflammation |journal=Crit. Rev. Oncol. Hematol. |volume=108 |issue= |pages=146–153 |year=2016 |pmid=27931833 |doi=10.1016/j.critrevonc.2016.11.003 |url=}}</ref><ref name="pmid27247222">{{cite journal |vauthors=Sohal DP, Mangu PB, Khorana AA, Shah MA, Philip PA, O'Reilly EM, Uronis HE, Ramanathan RK, Crane CH, Engebretson A, Ruggiero JT, Copur MS, Lau M, Urba S, Laheru D |title=Metastatic Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline |journal=J. Clin. Oncol. |volume=34 |issue=23 |pages=2784–96 |year=2016 |pmid=27247222 |pmc=5019760 |doi=10.1200/JCO.2016.67.1412 |url=}}</ref><ref name="pmid27120389">{{cite journal |vauthors=Frič P, Škrha J, Šedo A, Bušek P, Kmochová K, Laclav M, Solař S, Bunganič B, Zavoral M |title=Early pancreatic carcinogenesis - risk factors, early symptoms, and the impact of antidiabetic drugs |journal=Eur J Gastroenterol Hepatol |volume=28 |issue=7 |pages=e19–25 |year=2016 |pmid=27120389 |doi=10.1097/MEG.0000000000000646 |url=}}</ref>
The natural history of [[pancreatic cancer]] is as follows:<ref name="pmid27931833">{{cite journal |vauthors=Chang SC, Yang WV |title=Hyperglycemia, tumorigenesis, and chronic inflammation |journal=Crit. Rev. Oncol. Hematol. |volume=108 |issue= |pages=146–153 |year=2016 |pmid=27931833 |doi=10.1016/j.critrevonc.2016.11.003 |url=}}</ref><ref name="pmid27247222">{{cite journal |vauthors=Sohal DP, Mangu PB, Khorana AA, Shah MA, Philip PA, O'Reilly EM, Uronis HE, Ramanathan RK, Crane CH, Engebretson A, Ruggiero JT, Copur MS, Lau M, Urba S, Laheru D |title=Metastatic Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline |journal=J. Clin. Oncol. |volume=34 |issue=23 |pages=2784–96 |year=2016 |pmid=27247222 |pmc=5019760 |doi=10.1200/JCO.2016.67.1412 |url=}}</ref><ref name="pmid27120389">{{cite journal |vauthors=Frič P, Škrha J, Šedo A, Bušek P, Kmochová K, Laclav M, Solař S, Bunganič B, Zavoral M |title=Early pancreatic carcinogenesis - risk factors, early symptoms, and the impact of antidiabetic drugs |journal=Eur J Gastroenterol Hepatol |volume=28 |issue=7 |pages=e19–25 |year=2016 |pmid=27120389 |doi=10.1097/MEG.0000000000000646 |url=}}</ref>
*The symptoms of [[pancreatic cancer]] usually develop in the sixth decade of life, and start with symptoms such as [[jaundice]], light-colored stools, [[Urine|dark urine]], pain in the upper or middle [[abdomen]] and back, unexplained [[weight loss]], [[anorexia]] and [[fatigue]].  
*The symptoms of [[pancreatic cancer]] usually develop in the sixth decade of life, and start with symptoms such as [[jaundice]], [[Acholic stools|light-colored stools]], [[Urine|dark urine]], [[pain]] in the upper or middle [[abdomen]] and back, unexplained [[weight loss]], [[anorexia]] and [[fatigue]].  
*The symptoms of [[pancreatic cancer]] typically develop about 20-30 years after exposure to risk factors such as [[smoking]] and [[alcohol]]. Genetic factors such as alterations in [[Tumor suppressor gene|tumor suppressor genes]], [[Oncogene|oncogenes]] and different [[Signal transduction|signaling pathways]] may also be responsible.  
*The symptoms of [[pancreatic cancer]] typically develop about 20-30 years after exposure to risk factors such as [[smoking]] and [[alcohol]]. [[Genetic|Genetic factors]] such as alterations in [[Tumor suppressor gene|tumor suppressor genes]], [[Oncogene|oncogenes]] and different [[Signal transduction|signaling pathways]] may also be responsible.  
*If left untreated, patients with [[pancreatic cancer]] may progress to develop [[Exocrine gland|exocrine]] [[pancreatic insufficiency]] arising from [[pancreatic duct]] [[obstruction]] leading to [[malabsorption]], [[malnutrition]] and [[cachexia]]. Dudodenal [[obstruction]] and [[Bile duct|biliary]] [[obstruction]] may cause symptoms of [[Intestine|bowel]] [[obstruction]] and [[jaundice]]. Metastasis may occur to different sites.
*If left untreated, patients with [[pancreatic cancer]] may progress to develop [[Exocrine gland|exocrine]] [[pancreatic insufficiency]] arising from [[pancreatic duct]] [[obstruction]] leading to [[malabsorption]], [[malnutrition]] and [[cachexia]]. Dudodenal [[obstruction]] and [[Bile duct|biliary]] [[obstruction]] may cause symptoms of [[Intestine|bowel]] [[obstruction]] and [[jaundice]]. [[Metastasis]] may occur to different sites.


==Complications==
==Complications==
*Common complications of [[pancreatic cancer]] may arise as a result of the [[disease]] or [[therapy]]:<ref name="pmid28229252">{{cite journal |vauthors=Koulouris AI, Banim P, Hart AR |title=Pain in Patients with Pancreatic Cancer: Prevalence, Mechanisms, Management and Future Developments |journal=Dig. Dis. Sci. |volume=62 |issue=4 |pages=861–870 |year=2017 |pmid=28229252 |doi=10.1007/s10620-017-4488-z |url=}}</ref><ref name="pmid28281169">{{cite journal |vauthors=Ramsey ML, Conwell DL, Hart PA |title=Complications of Chronic Pancreatitis |journal=Dig. Dis. Sci. |volume=62 |issue=7 |pages=1745–1750 |year=2017 |pmid=28281169 |pmc=5667546 |doi=10.1007/s10620-017-4518-x |url=}}</ref><ref name="pmid28241470">{{cite journal |vauthors=Vujasinovic M, Valente R, Del Chiaro M, Permert J, Löhr JM |title=Pancreatic Exocrine Insufficiency in Pancreatic Cancer |journal=Nutrients |volume=9 |issue=3 |pages= |year=2017 |pmid=28241470 |pmc=5372846 |doi=10.3390/nu9030183 |url=}}</ref><ref name="pmid27013367">{{cite journal |vauthors=Poruk KE, Wolfgang CL |title=Palliative Management of Unresectable Pancreas Cancer |journal=Surg. Oncol. Clin. N. Am. |volume=25 |issue=2 |pages=327–37 |year=2016 |pmid=27013367 |doi=10.1016/j.soc.2015.11.005 |url=}}</ref><ref name="pmid27008166">{{cite journal |vauthors=Kapoor VK |title=Complications of pancreato-duodenectomy |journal=Rozhl Chir |volume=95 |issue=2 |pages=53–9 |year=2016 |pmid=27008166 |doi= |url=}}</ref><ref name="pmid26898789">{{cite journal |vauthors=Hucl T |title=[Malignant biliary obstruction] |language=Czech |journal=Cas. Lek. Cesk. |volume=155 |issue=1 |pages=30–7 |year=2016 |pmid=26898789 |doi= |url=}}</ref><ref name="pmid26818541">{{cite journal |vauthors=Dong J, Cong L, Zhang TP, Zhao YP |title=Pancreatic metastasis of renal cell carcinoma |journal=HBPD INT |volume=15 |issue=1 |pages=30–8 |year=2016 |pmid=26818541 |doi= |url=}}</ref>  
*Common [[Complication (medicine)|complications]] of [[pancreatic cancer]] may arise as a result of the [[disease]] or [[therapy]]:<ref name="pmid28229252">{{cite journal |vauthors=Koulouris AI, Banim P, Hart AR |title=Pain in Patients with Pancreatic Cancer: Prevalence, Mechanisms, Management and Future Developments |journal=Dig. Dis. Sci. |volume=62 |issue=4 |pages=861–870 |year=2017 |pmid=28229252 |doi=10.1007/s10620-017-4488-z |url=}}</ref><ref name="pmid28281169">{{cite journal |vauthors=Ramsey ML, Conwell DL, Hart PA |title=Complications of Chronic Pancreatitis |journal=Dig. Dis. Sci. |volume=62 |issue=7 |pages=1745–1750 |year=2017 |pmid=28281169 |pmc=5667546 |doi=10.1007/s10620-017-4518-x |url=}}</ref><ref name="pmid28241470">{{cite journal |vauthors=Vujasinovic M, Valente R, Del Chiaro M, Permert J, Löhr JM |title=Pancreatic Exocrine Insufficiency in Pancreatic Cancer |journal=Nutrients |volume=9 |issue=3 |pages= |year=2017 |pmid=28241470 |pmc=5372846 |doi=10.3390/nu9030183 |url=}}</ref><ref name="pmid27013367">{{cite journal |vauthors=Poruk KE, Wolfgang CL |title=Palliative Management of Unresectable Pancreas Cancer |journal=Surg. Oncol. Clin. N. Am. |volume=25 |issue=2 |pages=327–37 |year=2016 |pmid=27013367 |doi=10.1016/j.soc.2015.11.005 |url=}}</ref><ref name="pmid27008166">{{cite journal |vauthors=Kapoor VK |title=Complications of pancreato-duodenectomy |journal=Rozhl Chir |volume=95 |issue=2 |pages=53–9 |year=2016 |pmid=27008166 |doi= |url=}}</ref><ref name="pmid26898789">{{cite journal |vauthors=Hucl T |title=[Malignant biliary obstruction] |language=Czech |journal=Cas. Lek. Cesk. |volume=155 |issue=1 |pages=30–7 |year=2016 |pmid=26898789 |doi= |url=}}</ref><ref name="pmid26818541">{{cite journal |vauthors=Dong J, Cong L, Zhang TP, Zhao YP |title=Pancreatic metastasis of renal cell carcinoma |journal=HBPD INT |volume=15 |issue=1 |pages=30–8 |year=2016 |pmid=26818541 |doi= |url=}}</ref>  


===Malabsorption:===
===Malabsorption:===
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===Pain===
===Pain===
*Patients with advanced [[pancreatic cancer]] may develop intractable pain requiring [[Narcotic|narcotic analgesics]] and surgical [[Intervention (counseling)|intervention]] such as [[neurolysis]] of [[celiac ganglia]].<ref name="pmid28229252">{{cite journal |vauthors=Koulouris AI, Banim P, Hart AR |title=Pain in Patients with Pancreatic Cancer: Prevalence, Mechanisms, Management and Future Developments |journal=Dig. Dis. Sci. |volume=62 |issue=4 |pages=861–870 |year=2017 |pmid=28229252 |doi=10.1007/s10620-017-4488-z |url=}}</ref><ref name="pmid27111447">{{cite journal |vauthors=Dobosz Ł, Kaczor M, Stefaniak TJ |title=Pain in pancreatic cancer: review of medical and surgical remedies |journal=ANZ J Surg |volume=86 |issue=10 |pages=756–761 |year=2016 |pmid=27111447 |doi=10.1111/ans.13609 |url=}}</ref>
*Patients with advanced [[pancreatic cancer]] may develop intractable [[pain]] requiring [[Narcotic|narcotic analgesics]] and surgical [[Intervention (counseling)|intervention]] such as [[neurolysis]] of [[celiac ganglia]].<ref name="pmid28229252">{{cite journal |vauthors=Koulouris AI, Banim P, Hart AR |title=Pain in Patients with Pancreatic Cancer: Prevalence, Mechanisms, Management and Future Developments |journal=Dig. Dis. Sci. |volume=62 |issue=4 |pages=861–870 |year=2017 |pmid=28229252 |doi=10.1007/s10620-017-4488-z |url=}}</ref><ref name="pmid27111447">{{cite journal |vauthors=Dobosz Ł, Kaczor M, Stefaniak TJ |title=Pain in pancreatic cancer: review of medical and surgical remedies |journal=ANZ J Surg |volume=86 |issue=10 |pages=756–761 |year=2016 |pmid=27111447 |doi=10.1111/ans.13609 |url=}}</ref>
===Jaundice===
===Jaundice===
*[[Jaundice|Obstructive jaundice]] can present with features of [[cholangitis]]:
*[[Jaundice|Obstructive jaundice]] can present with features of [[cholangitis]]:
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**[[Acholic stools|Clay-colored stools]]
**[[Acholic stools|Clay-colored stools]]
**Dark [[urine]]
**Dark [[urine]]
**Yellowish discoloration of skin
**Yellowish discoloration of [[skin]]
**[[Itch|Pruritus]]
**[[Itch|Pruritus]]
**[[Abdominal pain|Right upper quadrant pain]]
**[[Abdominal pain|Right upper quadrant pain]]
Line 39: Line 39:
==Prognosis==
==Prognosis==
*The primary factors that influence [[prognosis]] are:
*The primary factors that influence [[prognosis]] are:
**Whether the tumor is localized and can be completely resected
**Whether the [[tumor]] is localized and can be completely [[Resection|resected]]
**Whether the tumor has spread to lymph nodes or elsewhere
**Whether the [[tumor]] has spread to [[Lymph node|lymph nodes]] or elsewhere
'''Staging and TNM (tumour, lymph node, metastasis) classification related to incidence, treatment, and prognosis:''' <ref name="pmid22592847">{{cite journal| author=Bond-Smith G, Banga N, Hammond TM, Imber CJ| title=Pancreatic adenocarcinoma. | journal=BMJ | year= 2012 | volume= 344 | issue=  | pages= e2476 | pmid=22592847 | doi=10.1136/bmj.e2476 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22592847  }} </ref>
'''Staging and TNM (tumour, lymph node, metastasis) classification related to incidence, treatment, and prognosis:''' <ref name="pmid22592847">{{cite journal| author=Bond-Smith G, Banga N, Hammond TM, Imber CJ| title=Pancreatic adenocarcinoma. | journal=BMJ | year= 2012 | volume= 344 | issue=  | pages= e2476 | pmid=22592847 | doi=10.1136/bmj.e2476 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22592847  }} </ref>
{|
{|
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=== Five year survival rate ===
=== Five year survival rate ===
* The percentage of people who live for a minimum of five years after diagnosis is called the 5- year survival rate.
* The percentage of people who live for a minimum of five years after [[diagnosis]] is called the 5- year [[survival rate]].
* Survival rates for exocrine pancreatic cancer:
* [[Survival rate|Survival rates]] for [[Exocrine gland|exocrine]] [[pancreatic cancer]]:
** Lifespan is found to be longer in patients treated with surgery, as opposed to other patients.
** Lifespan is found to be longer in [[Patient|patients]] treated with [[surgery]], as opposed to other [[Patient|patients]].
** The 5-year survival rate for people at various stages of pancreatic cancer are as follows based on the most recent statistics of the American Cancer Society are as follows:<ref name="urlPancreatic Cancer Survival Rates, by Stage">{{cite web |url=https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/survival-rates.html#references |title=Pancreatic Cancer Survival Rates, by Stage |format= |work= |accessdate=}}</ref>
** The 5-year [[survival rate]] for people at various stages of [[pancreatic cancer]] are as follows based on the most recent statistics of the [[American Cancer Society]] are as follows:<ref name="urlPancreatic Cancer Survival Rates, by Stage">{{cite web |url=https://www.cancer.org/cancer/pancreatic-cancer/detection-diagnosis-staging/survival-rates.html#references |title=Pancreatic Cancer Survival Rates, by Stage |format= |work= |accessdate=}}</ref>
*** Stage IA: 14%  
*** Stage IA: 14%  
*** Stage IB: 12%  
*** Stage IB: 12%  
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*** Stage III 3%
*** Stage III 3%
*** Stage IV 1%
*** Stage IV 1%
** Survival rates for neuroendocrine pancreatic tumors (treated with surgery) are as follows:
** Survival rates for [[Neuroendocrine tumors|neuroendocrine pancreatic tumors]] (treated with [[surgery]]) are as follows:
*** Stage I pancreatic NETs 61%  
*** Stage I [[Pancreas|pancreatic]] [[Neuroendocrine tumors|NETs]] 61%  
*** Stage II pancreatic NETs 52%
*** Stage II [[Neuroendocrine tumors|pancreatic NETs]] 52%
*** Stage III pancreatic NETs 41%
*** Stage III [[Neuroendocrine|pancreatic NETs]] 41%
*** Stage IV pancreatic NETs 16%.  
*** Stage IV [[Neuroendocrine tumors|pancreatic NETs]] 16%.  
** Five year survival rate of tumors not removed by surgery is 16%
** Five year [[survival rate]] of [[Tumor|tumors]] not removed by [[surgery]] is 16%


==References==
==References==

Revision as of 16:19, 15 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2] Sudarshana Datta, MD [3]

Overview

The symptoms of pancreatic cancer usually develop in the sixth decade of life, and start with symptoms such as jaundice, light-colored stools, dark urine, pain in the upper or middle abdomen and back, unexplained weight loss, anorexia and fatigue.Symptoms typically develop about 20-30 years after exposure to risk factors such as smoking and alcohol. Genetic factors such as alterations in tumor suppressor genes, oncogenes and different signaling pathways are responsible. If left untreated, patients with pancreatic cancer may progress to develop exocrine pancreatic insufficiency arising from pancreatic duct obstruction leading to malabsorption, malnutrition and cachexia. Dudodenal obstruction and biliary obstruction may cause symptoms of bowel obstruction and jaundice. Common complications of pancreatic cancer may arise as a result of the disease or therapy (surgical or medical). Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with complete remission extremely rare.

Natural History, Complications and Prognosis

The symptoms of pancreatic cancer usually develop in the sixth decade of life, and start with symptoms such as jaundice, light-colored stools, dark urine, pain in the upper or middle abdomen and back, unexplained weight loss, anorexia and fatigue. Common complications of pancreatic cancer may arise as a result of the disease or therapy and include malabsorption, pain, jaundice and symptoms of bowel obstruction. Prognosis is found to be better in patients treated with surgery, as opposed to other patients.

Natural History

The natural history of pancreatic cancer is as follows:[1][2][3]

Complications

Malabsorption:

Pain

Jaundice

Duodenal obstruction

Prognosis

Staging and TNM (tumour, lymph node, metastasis) classification related to incidence, treatment, and prognosis: [12]

Staging and TNM Classification related to Incidence, Treatment, and Prognosis
Stage TNM Classification Clinical Classification Incidence at diagnosis (%) 5-year survival rate (%)
0 Tis, N0, M0 Resectable 7.5 15.2
IA T1, N0, M0 — — —
IB T2, N0, M0 — — —
IIA T3, N0, M0 — — —
IIB T1-3, N1, M0 Locally advanced 29.3 6.3
III T4, any N, M0 — — —
IV Any T, any N, M1 Metastatic 47.2 1.6

Five year survival rate

References

  1. ↑ Chang SC, Yang WV (2016). "Hyperglycemia, tumorigenesis, and chronic inflammation". Crit. Rev. Oncol. Hematol. 108: 146–153. doi:10.1016/j.critrevonc.2016.11.003. PMID 27931833.
  2. ↑ Sohal DP, Mangu PB, Khorana AA, Shah MA, Philip PA, O'Reilly EM, Uronis HE, Ramanathan RK, Crane CH, Engebretson A, Ruggiero JT, Copur MS, Lau M, Urba S, Laheru D (2016). "Metastatic Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline". J. Clin. Oncol. 34 (23): 2784–96. doi:10.1200/JCO.2016.67.1412. PMC 5019760. PMID 27247222.
  3. ↑ Frič P, Škrha J, Šedo A, Bušek P, Kmochová K, Laclav M, Solař S, Bunganič B, Zavoral M (2016). "Early pancreatic carcinogenesis - risk factors, early symptoms, and the impact of antidiabetic drugs". Eur J Gastroenterol Hepatol. 28 (7): e19–25. doi:10.1097/MEG.0000000000000646. PMID 27120389.
  4. ↑ 4.0 4.1 Koulouris AI, Banim P, Hart AR (2017). "Pain in Patients with Pancreatic Cancer: Prevalence, Mechanisms, Management and Future Developments". Dig. Dis. Sci. 62 (4): 861–870. doi:10.1007/s10620-017-4488-z. PMID 28229252.
  5. ↑ Ramsey ML, Conwell DL, Hart PA (2017). "Complications of Chronic Pancreatitis". Dig. Dis. Sci. 62 (7): 1745–1750. doi:10.1007/s10620-017-4518-x. PMC 5667546. PMID 28281169.
  6. ↑ Vujasinovic M, Valente R, Del Chiaro M, Permert J, Löhr JM (2017). "Pancreatic Exocrine Insufficiency in Pancreatic Cancer". Nutrients. 9 (3). doi:10.3390/nu9030183. PMC 5372846. PMID 28241470.
  7. ↑ Poruk KE, Wolfgang CL (2016). "Palliative Management of Unresectable Pancreas Cancer". Surg. Oncol. Clin. N. Am. 25 (2): 327–37. doi:10.1016/j.soc.2015.11.005. PMID 27013367.
  8. ↑ Kapoor VK (2016). "Complications of pancreato-duodenectomy". Rozhl Chir. 95 (2): 53–9. PMID 27008166.
  9. ↑ Hucl T (2016). "[Malignant biliary obstruction]". Cas. Lek. Cesk. (in Czech). 155 (1): 30–7. PMID 26898789.
  10. ↑ Dong J, Cong L, Zhang TP, Zhao YP (2016). "Pancreatic metastasis of renal cell carcinoma". HBPD INT. 15 (1): 30–8. PMID 26818541.
  11. ↑ Dobosz Ł, Kaczor M, Stefaniak TJ (2016). "Pain in pancreatic cancer: review of medical and surgical remedies". ANZ J Surg. 86 (10): 756–761. doi:10.1111/ans.13609. PMID 27111447.
  12. ↑ Bond-Smith G, Banga N, Hammond TM, Imber CJ (2012). "Pancreatic adenocarcinoma". BMJ. 344: e2476. doi:10.1136/bmj.e2476. PMID 22592847.
  13. ↑ "Pancreatic Cancer Survival Rates, by Stage".



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