Pancreatic cancer is a malignant neoplasm of the pancreas. Each year in the United States, about 37,680 individuals are diagnosed with this condition and 34,290 die from the disease each year. In Europe more than 60,000 are diagnosed each year. Depending on the extent of the cancer at the time of diagnosis, the prognosis is generally regarded as poor; less than 5 percent of those diagnosed are still alive five years after diagnosis. Complete remission is still extremely rare. About 95% of exocrine pancreatic cancers are adenocarcinomas (ICDO: 3). The remaining 5% include adenosquamous carcinomas, squamous cell carcinomas, and giant cell carcinomas. Exocrine pancreatic cancers are far more common than endocrine pancreatic cancers (islet cell carcinomas), which make up about 1% of total cases.

Presentation

Pancreatic cancer is sometimes called a "silent killer" because early pancreatic cancer often does not cause symptoms, and the later symptoms are usually non-specific and varied. Therefore, pancreatic cancer is often not diagnosed until it is advanced. 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 (anorexia), and/or nausea and vomiting;
• significant weight loss;
• painless jaundice (yellow skin/eyes, dark urine) when a cancer of the head of the pancreas (about 60% of cases) obstructs the common bile duct as it runs through the pancreas. This may also cause pale-colored stool and steatorrhea.

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 has a risk ratio of 1.74 with regard to pancreatic cancer; a decade of non-smoking after heavy smoking is associated with a risk ratio of 1.2.
• Diets low in vegetables and fruits
• 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 geneand PALB2 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.