Pancreatic Cancer

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Pancreatic Cancer
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Specialty scores for Pancreatic Cancer

Overview

Pancreatic cancer is a highly aggressive malignancy arising from a glandular organ, called pancreas. It is the fourth leading cause of cancer deaths in the United States. This is attributed to the late presentation and rapid metastasis of this cancer. There are various types of pancreatic cancers. The most common type is adenocarcinoma (an exocrine pancreatic cancer). It represents more than 80% of pancreatic cancers. Hence, this description will mainly cover the pancreatic adenocarcinoma. About 75% of pancreatic cancers involve the pancreatic head or neck. The remaining 15% to 25% occur in the body or tail of the pancreas.

Causes

  • Cigarette smoking (the most common cause)
  • Chronic pancreatitis
  • Diabetes mellitus
  • Obesity
  • Cigarette smoking (the most common cause)
  • Dietary factors:
    • Diet low in fresh fruits and vegetables
    • Consumption of red meat confers a higher risk of pancreatic cancer
  • Hereditary (genetic) factors:
    • Family history of pancreatic cancer
    • Hereditary pancreatitis
    • KRAS2 gene mutation

Clinical Presentation

Patients with pancreatic cancer may experience the following signs and symptoms:

  • Remarkable weight loss
  • Malaise
  • Painless obstructive jaundice: A pathognomic sign of cancer of head of the pancreas
  • Epigastric pain (may radiate to the midback)
  • Diabetes mellitus
  • Pruritis (intense itching due to obstruction of the bile duct and the buildup of bile in blood)
  • Migratory thrombophlebitis (Trousseau sign) and superficial venous thrombosis: Maybe the initial presentation
  • Palpable gallbladder (Courvoisier sign)
  • Advanced disease
    • Ascites (abnormal accumulation of fluid in the abdominal cavity)
    • Splenomegaly from obstruction of portal vein
    • Hepatomegaly from liver metastases
    • Metastasis (spread) to paraumbilical area (or Sister Mary Joseph nodules)
    • Metastasis to cervical nodes, including those behind the left clavicle (Virchow's node)

Diagnosis

  • Imaging like CT scan abdomen: Shows the presence of pancreatic mass and aids in determining the stage of cancer
  • Endoscopic ultrasound guided or CT guided tissue biopsy
  • Blood CA-19-9 levels: A gold-standard tumor marker elevated in most if not all cases of pancreatic cancer

Treatment

The only definitive therapy is surgical resection. However, pancreatic cancer has a poor prognosis. Moreover, cancer may not be amenable to surgery in most instances. Chemotherapy and/or radiation therapy may be required.

FDA Approved Medicines

  • FDA approved secretin, sold as SecreFlo, manufactured by Repligen as to aid in the diagnosis of pancreatic dysfunction and gastrinoma ( Gastrinoma | Pancreatic Cancer ) in year 2002.
  • FDA approved irinotecan liposome injection, sold as Onivyde, manufactured by Merrimack for the treatment of metastatic pancreatic cancer following gemcitabine-based therapy ( Pancreatic Cancer ) in year 2015.
  • FDA approved sunitinib malate, sold as Sutent, manufactured by Pfizer for the treatment of pancreatic neuroendocrine tumors ( Neuroendocrine Tumor | Pancreatic Cancer ) in year 2011.