Pancreatic cancer is a malignant tumor of the pancreas. Each year about 37,680 individuals in the United States are diagnosed with this condition, and 34,290 die from the disease. In Europe more than 60,000 are diagnosed each year. Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with less than 5 percent of those diagnosed still alive five years after diagnosis, and complete remission still extremely rare. About 95 percentFact: date=July 2008 of pancreatic tumors are adenocarcinomas (ICDO: 3). The remaining 5 percent include other tumors of the exocrine pancreas (e.g., serous cystadenomas), acinar cell cancers, and pancreatic neuroendocrine tumors (such as insulinomas, ICDO: 1, ICDO: 3). These tumors have a completely different diagnostic and therapeutic profile, and generally a more favorable prognosis.

Presentation

Pancreatic cancer is sometimes called a "silent disease" because early pancreatic cancer often does not cause symptoms, and the later symptoms are usually non-specific and varied. Common symptoms include:

• pain in the upper abdomen that typically radiates to the back and is relieved by leaning forward (seen in carcinoma of the body or tail of the pancreas);
• loss of appetite, or nausea and vomiting;
• significant weight loss;
• painless jaundice (yellow skin/eyes, dark urine) related to bile duct obstruction (carcinoma of the head of the pancreas). This may also cause acholic stool and steatorrhea.

All of these symptoms can have multiple other causes. Therefore, pancreatic cancer is often not diagnosed until it is advanced.

Jaundice occurs when the tumor grows and obstructs the common bile duct, which runs partially through the head of the pancreas. Tumors of the head of the pancreas (approximately 60% of cases) are more likely to cause jaundice by this mechanism.

Trousseau sign, in which blood clots form spontaneously in the portal blood vessels, the deep veins of the extremities, or the superficial veins anywhere on the body, is sometimes associated with pancreatic cancer.

Clinical depression has been reported in association with pancreatic cancer, sometimes presenting before the cancer is diagnosed. However, the mechanism for this association is not known.

Predisposing factors

Risk factors for pancreatic cancer include:

• Age (particularly over 60)
• Male gender
• African-American ethnicity
• Smoking. Cigarette smoking nearly doubles one's risk, and the risk persists for at least a decade after quitting.
• Diets low in vegetables and fruits Fact: date=August 2008
• Diets high in red meat
• Obesity
• Diabetes mellitus
• Chronic pancreatitis has been linked, but is not known to be causal
• Helicobacter pylori infection
• Family history, 5-10% of pancreatic cancer patients have a family history of pancreatic cancer. The genes responsible for most of this clustering in families have yet to be identified. Pancreatic cancer has been associated with the following syndromes; autosomal recessive ataxia-telangiectasia and autosomal dominantly inherited mutations in the BRCA2 gene, Peutz-Jeghers syndrome due to mutations in the STK11 tumor suppressor gene, hereditary non-polyposis colon cancer (Lynch syndrome), familial adenomatous polyposis, and the familial atypical multiple mole melanoma-pancreatic cancer syndrome (FAMMM-PC) due to mutations in the CDKN2A tumor suppressor gene.
• Gingivitis or periodontal disease.
• Alcohol might be a risk factor – see Pancreatic cancer section in Alcohol and cancer