Pancreatic Cancer

Pancreatic cancer is one of the most aggressive malignancies, often diagnosed at advanced stages due to vague early symptoms. It has the lowest survival rate among common cancers. Here’s a detailed yet concise overview:

1. Types

• • Pancreatic Ductal Adenocarcinoma (PDAC)
    • 90–95% of cases.Arises from exocrine gland cells lining the pancreatic ducts.
    • Highly aggressive, resistant to treatment.
  • Pancreatic Neuroendocrine Tumors (PNETs)
    • 3–5%.Develop from hormone-producing cells (e.g., insulinomas, gastrinomas).
    • Often slower-growing; better prognosis than PDAC.
  • Rare Types:Acinar cell carcinoma, pancreatoblastoma.

2. Symptoms

• • Early:Often absent or nonspecific (indigestion, vague abdominal discomfort).
  • Classic Triad (Advanced Disease):
    1. Painless jaundice(yellow skin/eyes, dark urine, itching) – if tumor in the pancreatic head.
    2. Unexplained weight loss(>10% body weight).
    3. Epigastric or back pain(dull, persistent; worse when lying down).
  • Other Signs:
    • New-onset diabetes, light-colored stools, loss of appetite, thrombophlebitis (migratory blood clots).

3. Risk Factors

• • Age:>90% occur in adults >55 yrs; peak at 65–75 yrs.
  • Smoking:↑ Risk 2–3×.
  • Chronic Pancreatitis:Long-term inflammation (especially hereditary).
  • Diabetes:New-onset diabetes in adults may be an early sign.
  • Obesity & Diet:High-fat, processed meat consumption.
  • Genetics:
    • Inherited Syndromes:BRCA2, PALB2, Lynch syndrome, Peutz-Jeghers, FAMMM (melanoma).
    • Family History:5–10% have a familial link.

4. Diagnosis

• • Imaging:
    • CT with Pancreatic Protocol (Triple-Phase):Gold standard for detection/staging.
    • MRI/MRCP:Evaluates ductal structures; useful for small tumors.
    • Endoscopic Ultrasound (EUS):Combines scope/ultrasound; allows biopsy.
  • Biopsy:
    • Via EUS or CT-guided needle, confirms diagnosis.
  • Tumor Markers:
    • CA 19-9:Elevated in 80% of PDAC (but not specific; used for monitoring).
  • Genetic Testing:
    • Recommended for all patients (guides therapy, especially if BRCAor Lynch-related).

5. Treatment

• • Treatment depends on stage, location, and patient fitness.
  • Resectable Tumors (15–20% of cases)
  • Surgery:
    • Whipple Procedure (Pancreaticoduodenectomy): For head tumors.
    • Distal Pancreatectomy: For body/tail tumors.
  • Adjuvant Therapy:
    • Chemo (FOLFIRINOX or gemcitabine/capecitabine) post-surgery to reduce recurrence.
  • Locally Advanced (Unresectable)
    • Chemoradiation: FOLFIRINOX or gemcitabine-based chemo ± radiation.
    • Borderline Resectable: Neoadjuvant chemo → reassessment for surgery.

• • Metastatic (Stage IV)
    • Chemotherapy:
      • 1st-line: FOLFIRINOX (fit patients) or gemcitabine + nab-paclitaxel.
      • 2nd-line: Nanoliposomal irinotecan + 5-FU or modified FOLFOX.
    • Targeted Therapy:
      • Olaparib (PARP inhibitor) for BRCA-mutated PDAC.
      • Larotrectinib/entrectinib for NTRK fusion-positive tumors.
    • Immunotherapy: Only for MSI-H/dMMR tumors (pembrolizumab).

6. Prognosis & Key Factors

• • Overall, 5-Year Survival:~11% (improving slowly with new therapies).
  • Favorable Factors:
    • Early stage, surgical resection, PNET subtype, good response to chemo.
  • Poor Prognosis:
    • Metastasis, high CA 19-9, weight loss, poor performance status.

1. 7. Prevention & Early Detection

• • High-Risk Groups (e.g., BRCAcarriers, familial PC):
    • Surveillance with annual MRI/EUS + CA 19-9.
  • Lifestyle:
    • Smoking cessation, weight control, and limited alcohol.
  • Diabetes Management: New-onset diabetes warrants pancreatic evaluation.

• • Rapid Decline: Often requires early hospice involvement.

Multidisciplinary care (surgery, oncology, GI, palliative care) is essential.