Pancreatic cancer natural history, complications and prognosis
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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
Natural History
- 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.
- 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 genes, oncogenes and different signaling pathways may also be 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.
Complications
- Common complications of pancreatic cancer may arise as a result of the disease or therapy:
Malabsorption:
- Exocrine pancreatic insufficiency due to pancreatic duct obstruction by the tumor may lead to malabsorption. Malabsorption in patients presents with anorexia, weight loss, and diarrhea.
Pain
- Patients with advanced pancreatic cancer may develop intractable pain requiring narcotic analgesics and surgical intervention such as neurolysis of celiac ganglia.
Jaundice
- Obstructive jaundice can present with features of cholangitis:
- Fever and chills
- Nausea, vomiting
- Clay-colored stools
- Dark urine
- Yellowish discoloration of skin
- Pruritus
- Right upper quadrant pain
- Anorexia
- Patients may require Endoscopic decompression with stent placement in patients due to biliary obstruction.
Duodenal obstruction
- Patients may develop duodenal obstruction as a result of complications of surgery.
- Duodenal obstruction may be treated with endoscopic stenting or gastrojejunostomy.
Prognosis
- The primary factors that influence prognosis are:
- Whether the tumor is localized and can be completely resected
- Whether the tumor has spread to lymph nodes or elsewhere
- Staging and TNM (tumour, lymph node, metastasis) classification related to incidence, treatment, and prognosis: [1]
| 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 |
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 Lifespan is found to be longer in patients treated with surgery, as opposed to other patients. The 5-year survival rate for people at various stages of pancreatic cancer are as follows:
stage IA: 14%
stage IB cancer 12% stage IIA 7%
stage IIB 5%
stage III 3% Stage IV 1% • Survival rates for neuroendocrine pancreatic tumors (treated with surgery) • stage I pancreatic NETs 61%. • stage II pancreatic NETs 52%. • stage III pancreatic NETs 41%. • Stage IV pancreatic NETs 16%. Still, • tumors not removed by surgery was 16%
References
- ↑ Bond-Smith G, Banga N, Hammond TM, Imber CJ (2012). "Pancreatic adenocarcinoma". BMJ. 344: e2476. doi:10.1136/bmj.e2476. PMID 22592847.