Pancreatic cancer is currently known as the fourth leading cause of death in both genders (Oliveira-Cunha et al.
, 2007) making up 6% of all cancer-related deaths. In addition, the incidence of this has been slowly rising. These cancers can arise from both exocrine and endocrine parts of the pancreas, 95% being from the exocrine half.
As to distribution, around 75% are seen within the head or neck of the pancreas, 15-20% in the body and 5-10% in the tail. Typically, this would first metastasize to regional lymph nodes, followed by the liver, and less commonly, to the lungs.Furthermore, it can also directly invade organs around it, such as the stomach and intestines and colon.
It can also spread to the skin as painful nodular metastases. In terms of etiology, the molecular genetics of pancreatic adenocarcinoma have been seen to play a role. Around 80-95% have mutations in the KRAS2 gene and 85-98% have alterations to the CDKN2 gene. Families with BRCA-2 mutations, more commonly associated with risk for breast cancer, are also at greater risk for pancreatic cancer.Diseases processes like diabetes and chronic pancreatic inflammation are seen to bring predisposition to pancreatic cancer, as these individuals are seen to have greater incidence of the cancer and at an earlier age. Study has also identified some exposures to be a risk.
Smoking is a factor, and as alcohol can cause chronic pancreatitis, heavy alcohol abuse may be a risk as well. Currently, research still continues to uncover further risk factors. An example of this is an observed association between periodontal disease and an increased risk for pancreatic cancer.Furthermore, it was demonstrated that the greater the severity of periodontal disease, such as the with recent tooth loss, the greater the risk for pancreatic cancer. (Michaud et al. , 2007) The early clinical diagnosis of pancreatic cancer is often a challenging task. Unfortunately, its manifestations are often very nonspecific and subtle until late in the disease.
Common nonspecific symptoms are a gradual onset of anorexia, malaise, nausea, fatigue, and mid-epigastric or back pain.(Brender, 2007) Usually pain is continuous and with nighttime pain being a frequent issue. Weight loss to a large degree is typical. If located in the head of the pancreas, the yellowish skin color change of obstructive jaundice is commonly noted, sometimes with a darkening of the urine, lightening of the school and itchiness.
Depression may also be factor, and at times, may even be the most prominent symptom on presentation. Diagnostic tests would be the next step, however laboratory findings in patients with pancreatic cancer are usually nonspecific as well.Just like many chronic diseases, a mild normochromic anemia may be present, sometimes with thrombocytosis. If the patient had obstructive jaundice, there would be significant elevations in bilirubin, alkaline phosphatase, gamma-glutamyl transpeptidase, aspartate aminotransferase and alanine aminotransferase. In some, serum amylase or lipase levels may be high as well.
Overall, the best useful tumor marker for pancreatic carcinoma is carbohydrate antigen 19-9 (CA 19-9).