Pancreatic cancer

General concepts and epidemiology

According to the American Cancer Society, it is estimated that 43,140 Americans will be diagnosed with pancreatic carcinoma in 2010 with an estimated 36,800 deaths. This represents the 10th most commonly diagnosed malignancy, but the fourth leading cause of cancer-related death (1). Pancreatic adenocarcinoma is one of the most lethal of all malignancies with a 1-year survival of 20–25% and a 5-year survival rate of approximately 5% (2). Survival for pancreatic adenocarcinoma remains dismally low despite advances in diagnostic and therapeutic development over the past several years. Currently, the only potentially curative treatment is surgical resection, which is only an option for 15–20% of patients. For those who are surgical candidates, 5-year survival following pancreaticoduodenectomy remains low at 25–30% in patients with no nodal involvement.

Tumors arising from the pancreas can be exocrine or endocrine in origin. The most common type of exocrine tumor of the pancreas is ductal adenocarcinoma. Adenosquamous, squamous, and giant cell tumors are much less common. Acinar cell carcinomas are rare and have a similar prognosis as for ductal carcinoma. Pancreatic neuroendocrine tumors such as insulinoma, glucagonoma, and gastrinoma are uncommon and are often associated with other endocrine abnormalities. Pancreatic endocrine tumors are usually slow growing and are typically found in the body or tail of the pancreas. Benign cysts, pseudocysts, and cystadenomas may occur within the pancreas, although malignant cystic neoplasms may also occur.