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  • Print publication year: 2015
  • Online publication date: November 2015

15 - Management of cancer of the exocrine pancreas

Summary

Introduction

Pancreatic cancer is the fifth commonest cause of cancer mortality in the UK. The major risk factors include smoking, diet and a history of previous total gastrectomy. There is also an association between long-standing diabetes and pancreatic cancer. Surgery is the only curative option, but fewer than 20% of patients are suitable for this. Chemotherapy is the mainstay of treatment for fit patients with advanced or metastatic cancers. Chemoradiation is an option for locally advanced inoperable (LAPC) or borderline resectable disease. Palliative care and psychosocial support are important in the management of this challenging disease.

Types of pancreatic tumour

Benign cysts can be congenital and arise from anomalous development of the pancreatic ducts. Pseudocysts are loculated collections of fluid arising from necrosis, inflammation or haemorrhage, which usually occur as a complication of acute pancreatitis. They are often solitary, can measure 5–10 cm and are often found adjacent to the pancreas in the region of the tail. Benign cystadenomas occur in elderly women and are found incidentally at autopsy or during other investigations. Microcystic and papillary–cystic are other variants found in younger women. The types of pancreatic tumour are shown in Table 15.1.

Incidence and epidemiology

There are about 8800 new cases of pancreatic cancer in the UK each year and 8700 die from the disease. The annual incidence is 9.7/100,000; peak incidence occurs for men in their eighth decade and women in their ninth decade.

Pancreatic cancer is the fifth leading cause of cancer death overall (5% of cancer mortality). The incidence is roughly equal in males and females. Most cases of the disease (80%) occur in the head of the pancreas.

Carcinoma of the exocrine pancreas

Risk factors and aetiology

Three per cent of pancreatic cancers may be inherited. Cancer family syndromes include inherited chronic pancreatitis, inherited diabetes mellitus and ataxia telangectasia syndrome.

Cigarette smoking doubles the risk. More than 1 in 4 pancreatic cancers in the UK are caused through smoking. The use of smokeless tobacco also increases the risk.

A diet rich in protein and carbohydrates and poor in fruit and fibre increases the risk of pancreatic cancer; processed meat may increase the risk.

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