Pancreatic Cancer Etiology:

The most common cause of pancreatic cancer is smoking which accounts for 25 -- 30% of cases (Surveillance, Epidemiology and End Results Program). Other factors include hereditary pancreatic cancers, adults with diabetes of minimum duration two years, hereditary pancreatic, and a history of other family cancers (GUT. Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas). The Consensus Guidelines of the International Association of Pancreatology advises that patients with a genetic history of pancreatic cancer should be referred to specialist centers where they can receive diagnosis of pancreatic diseases, genetic counseling, and advice on secondary screening (Ulrich et al., 2001).

Pathology:

Most pancreatic cancers (about 90%) originate in the ductal region and are usually discovered when they are locally advanced. They are called ductal adenocarcinoma. Others (80-90%) occur in the head of the gland (GUT). Lymph node metastasis is common as well as perineural infiltration and vascular invasion. Pancreatic cancer is graded into different stages in order to distinguish and treat them.

Clinical features

Aside from the associated features mentioned before such as late onset diabetes mellitus or acute pancreatitis, other pointers include marked and rapid weight loss, persistent back pain, jaundice, vomiting, malaise, ascetisis, enlarged lymph node (Virchow's node), and abdominal mass. These associations (excepting vomiting and malaise) usually indicate an incurable situation, whilst jaundice can indicate recovery or fatality depending on its region and spread (GUT).

Success of ultrasound is as high as 80 -- 95%. Ultrasound is, however, harder to use in body and tail and here, the second step would involve using computerized tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), and/or magnetic resonance (MR) as well as magnetic resonance angiography (MRA), all of which will use electronic means to accurately identify and localize the tumor in the majority of grade B. cases (GUT).
Sometimes, endosonography and/or laparoscopy with laparoscopic ultrasonography are used.

Diagnosis also involves obtaining a tissue diagnosis during endoscopic procedures especially for patients who are slated for palliative forms of treatment and/or patients who have a mass in the pancreas. However, failure to procure tissue diagnosis should not prevent continuance with surgery.

Treatment:

Treatment is largely palliative with the intent to mitigate and relieve symptoms. Stenting or surgical bypass is used with similar results in both and advantages and disadvantages in either case. Stenting is commonly used with patients who have serious comorbid disease and cannot receive surgery. Duodenal obstruction is treated surgically. Resectional surgery is used to treat the cancer, whilst endoscopic or percutaneous biliary stenting is employed to relieve jaundice.

Chemotherapy and radiotherapy are widely used as both palliative treatment and supplementary to surgery, although far more evidence-based tests need to be conducted on the latter to substantiate their efficacy…