Pancreatic cancer is the fourth most common cause of cancer death in the US and the seventh most common cancer death globally.
It has a 5-year survival of 5%, with disease mortality remaining as high as 99%. Over 330,000 deaths worldwide are attributed to pancreatic cancer every year, with 338,000 cases diagnosed in 2012. About 55% of these cases occur in the developed world.
The pancreas is a gland that lies adjacent to the stomach and produces hormones like insulin, glucagon and somatostatin that are important for the regulation of digestion, as well as enzymes (including trypsin, chymotrypsin, lipases and amylases) that play a critical role in digestion and are secreted into the duodenum through two pancreatic ducts. Although the pancreas is composed of a large number of different cell types, due to the number of hormones and enzymes it produces, 85% of pancreatic cancers are pancreatic adenocarcinomas1, which are derived from the cells that make digestive enzymes.
The symptoms of pancreatic cancer include jaundice, abdominal or back pain, weight loss, changes in stool and/or urine color and loss of appetite. Unfortunately, these symptoms are sufficiently general, and frequently do not occur until the tumor is well advanced so that pancreatic cancer is often not diagnosed until the disease is advanced.2 Pancreatic cancer is rare in patients under the age of 40 and more than half the cases occur in patients over 70.3 The risk factors for pancreatic cancer include smoking, diabetes and obesity. 5-10% of pancreatic cancer is thought to be hereditary. The relatively late diagnosis of pancreatic cancer and the proximity of the pancreas to the duodenum and liver (the bile duct joins the pancreatic duct before entering the duodenum) as well as it’s position next to the stomach means that local spread of pancreatic cancer is a significant problem and the prognosis for patients with pancreatic cancer is generally poor. The diagnosis of pancreatic cancer is usually based on one or more imaging techniques (ultrasound, CT) and ultimately, biopsy.
Pancreatic cancer is treated with surgery, radiation therapy and chemotherapy (in addition to palliative care). Drugs used to treat pancreatic cancer include nucleoside analogs (gemcitabine 5-FU) that inhibit nucleic acid synthesis, taxanes (paclitaxel, docetaxol), which inhibit microtubule formation, and platinum containing compounds (cisplatin, oxaliplatin), which are alkylating agents, and inhibit DNA synthesis.
Investigations of the genetic based of pancreatic cancer have identified 3 genes that are associated with the hereditary cases: PALB2, BrCa2 and p16. PALB2 and BrCa2 are both involved in the same DNA repair enzyme complex, while p16 plays an important role in regulating the cell cycle and is known tumor suppressor gene. Analysis of non-hereditary cases of pancreatic cancer has identified approximately 100 genes where mutations have been associated with malignant transformation. These genes represent a variety of different functional groups, including cell cycle regulation, cytokines and growth factors, as well as cytokine and growth factor receptor genes.4-6
Pancreatic cancer is the seventh most common cause of cancer deaths, resulting in 330,000 deaths worldwide.7 Pancreatic cancer is more common in the developed world and in the United States, it is the fourth most common cause of deaths due to cancer.8 Pancreatic adenocarcinoma typically has a poor prognosis: after diagnosis, 25% of people survive one year and only 5% live for five years.7,9 There are approximately 46,000 cases of pancreatic cancer annually in the US and approximately 40,000 deaths.3 Pancreatic cancer is responsible for 6% of cancer deaths each year.8 and is the seventh highest cause of death from cancer worldwide. Globally, pancreatic cancer is the 11th most common cancer in women and the 12th most common in men.