Pancreatic Cancer - 2014 update from Am Fam Physician

Pancreatic cancer remains the fourth leading cause of cancer-related deaths in the United States.

Risk factors include:

- family history
- smoking
- chronic pancreatitis
- obesity
- diabetes mellitus
- heavy alcohol use
- possible dietary factors

Symptoms

Because more than two-thirds of adenocarcinomas occur in the head of the pancreas, abdominal pain, jaundice, pruritus, dark urine, and acholic stools may be presenting symptoms.

Diagnosis

In symptomatic patients, the serum tumor marker cancer antigen 19-9 can be used to confirm the diagnosis and to predict prognosis and recurrence after resection.

Pancreas protocol computed tomography is considered standard for the diagnosis and staging of pancreatic cancer.

Treatment

Surgery


Although surgical resection is the only potentially curative treatment for pancreatic ductal adenocarcinomas, less than 20% of surgical candidates survive five years. The decision on resectability requires multidisciplinary consultation. Pancreatic resections should be performed at institutions that complete at least 15 of the surgeries annually.

Chemotherapy

Postoperatively, use of gemcitabine or fluorouracil/leucovorin as adjuvant chemotherapy improves overall survival by several months. However, more than 80% of patients present with disease that is not surgically resectable. For patients with locally advanced or metastatic disease, chemoradiotherapy with gemcitabine or irinotecan provides clinical benefit and modest survival improvement.

Palliative care

Palliation should address pain control, biliary and gastric outlet obstruction, malnutrition, thromboembolic disease, and depression.

Jon Lord, the keyboardist of the pioneering British hard-rock band Deep Purple, died of pancreatic cancer in 2012 and at age 71. Here is David Coverdale's eulogy for Jon Lord: David Coverdale remembers his first meetings with Jon Lord - supporting Deep Purple, joining Deep Purple and rehearsing for the Burn album:



References:

Diagnosis and Management of Pancreatic Cancer. De La Cruz MS1, Young AP2, Ruffin MT2. Am Fam Physician. 2014 Apr 15;89(8):626-632.
http://www.ncbi.nlm.nih.gov/pubmed/24784121

Jon Lord, Keyboardist With Deep Purple, Dies at 71. NYTimes http://buff.ly/1kC6iOD

Image source: Wikipedia, public domain.

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