Pancreatic cancer

Pancreatic cancer
Diagram showing the position of the pancreas CRUK 356.svg
Diagram showing the position of the pancreas, behind the stomach (which is transparent in this schematic).
SpecialtyOncology
SymptomsYellow skin, abdominal or back pain, unexplained weight loss, light-colored stools, dark urine, loss of appetite[1]
Usual onsetAfter 40 years old[2]
Risk factorsTobacco smoking, obesity, diabetes, certain rare genetic conditions[2]
Diagnostic methodMedical imaging, blood tests, tissue biopsy[3][4]
PreventionNot smoking, maintaining a healthy weight, low red meat diet[5]
TreatmentSurgery, radiotherapy, chemotherapy, palliative care[1]
PrognosisLife expectancy 4-6 months;[6] Five year survival rate 5%[7][8]
Frequency393,800 (2015)[9]
Deaths411,600 (2015)[10]

Pancreatic cancer arises when cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a mass. These cancerous cells have the ability to invade other parts of the body.[11] There are a number of types of pancreatic cancer.[7] The most common, pancreatic adenocarcinoma, accounts for about 85% of cases, and the term "pancreatic cancer" is sometimes used to refer only to that type.[7] These adenocarcinomas start within the part of the pancreas which makes digestive enzymes.[7] Several other types of cancer, which collectively represent the majority of the non-adenocarcinomas, can also arise from these cells.[7] One to two percent of cases of pancreatic cancer are neuroendocrine tumors, which arise from the hormone-producing cells of the pancreas.[7] These are generally less aggressive than pancreatic adenocarcinoma.[7]

Signs and symptoms of the most-common form of pancreatic cancer may include yellow skin, abdominal or back pain, unexplained weight loss, light-colored stools, dark urine, and loss of appetite.[1] There are usually no symptoms in the disease's early stages, and symptoms that are specific enough to suggest pancreatic cancer typically do not develop until the disease has reached an advanced stage.[1][2] By the time of diagnosis, pancreatic cancer has often spread to other parts of the body.[7][12]

Pancreatic cancer rarely occurs before the age of 40, and more than half of cases of pancreatic adenocarcinoma occur in those over 70.[2] Risk factors for pancreatic cancer include tobacco smoking, obesity, diabetes, and certain rare genetic conditions.[2] About 25% of cases are linked to smoking,[3] and 5–10% are linked to inherited genes.[2] Pancreatic cancer is usually diagnosed by a combination of medical imaging techniques such as ultrasound or computed tomography, blood tests, and examination of tissue samples (biopsy).[3][4] The disease is divided into stages, from early (stage I) to late (stage IV).[12] Screening the general population has not been found to be effective.[13][14]

The risk of developing pancreatic cancer is lower among non-smokers, and people who maintain a healthy weight and limit their consumption of red or processed meat.[5] A smoker's chance of developing the disease decreases if they stop smoking and almost returns to that of the rest of the population after 20 years.[7] Pancreatic cancer can be treated with surgery, radiotherapy, chemotherapy, palliative care, or a combination of these.[1] Treatment options are partly based on the cancer stage.[1] Surgery is the only treatment that can cure pancreatic adenocarcinoma,[12] and may also be done to improve quality of life without the potential for cure.[1][12] Pain management and medications to improve digestion are sometimes needed.[12] Early palliative care is recommended even for those receiving treatment that aims for a cure.[15][16]

In 2015, pancreatic cancers of all types resulted in 411,600 deaths globally.[10] Pancreatic cancer is the fifth most-common cause of death from cancer in the United Kingdom,[17] and the third most-common in the United States.[18] The disease occurs most often in the developed world, where about 70% of the new cases in 2012 originated.[7] Pancreatic adenocarcinoma typically has a very poor prognosis: after diagnosis, 25% of people survive one year and 5% live for five years.[7][8] For cancers diagnosed early, the five-year survival rate rises to about 20%.[19] Neuroendocrine cancers have better outcomes; at five years from diagnosis, 65% of those diagnosed are living, though survival varies considerably depending on the type of tumor.[7]

Types

The pancreas has many functions, served by the endocrine cells in the islets of Langerhans and the exocrine acinar cells. Pancreatic cancer may arise from any of these and disrupt any of their functions.

The many types of pancreatic cancer can be divided into two general groups. The vast majority of cases (about 95%) occur in the part of the pancreas which produces digestive enzymes, known as the exocrine component. There are several sub-types of exocrine pancreatic cancers, but their diagnosis and treatment have much in common. The small minority of cancers that arise in the hormone-producing (endocrine) tissue of the pancreas have different clinical characteristics and are called pancreatic neuroendocrine tumors, sometimes abbreviated as "PanNETs". Both groups occur mainly (but not exclusively) in people over 40, and are slightly more common in men, but some rare sub-types mainly occur in women or children.[20][21]

Exocrine cancers

The exocrine group is dominated by pancreatic adenocarcinoma (variations of this name may add "invasive" and "ductal"), which is by far the most common type, representing about 85% of all pancreatic cancers.[2] Nearly all these start in the ducts of the pancreas, as pancreatic ductal adenocarcinoma (PDAC).[22] This is despite the fact that the tissue from which it arises – the pancreatic ductal epithelium – represents less than 10% of the pancreas by cell volume, because it constitutes only the ducts (an extensive but capillary-like duct-system fanning out) within the pancreas.[23] This cancer originates in the ducts that carry secretions (such as enzymes and bicarbonate) away from the pancreas. About 60–70% of adenocarcinomas occur in the head of the pancreas.[2]

The next most common type, acinar cell carcinoma of the pancreas, arises in the clusters of cells that produce these enzymes, and represents 5% of exocrine pancreas cancers.[24] Like the 'functioning' endocrine cancers described below, acinar cell carcinomas may cause over-production of certain molecules, in this case digestive enzymes, which may cause symptoms such as skin rashes and joint pain.

Cystadenocarcinomas account for 1% of pancreatic cancers, and they have a better prognosis than the other exocrine types.[24]

Pancreatoblastoma is a rare form, mostly occurring in childhood, and with a relatively good prognosis. Other exocrine cancers include adenosquamous carcinomas, signet ring cell carcinomas, hepatoid carcinomas, colloid carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with osteoclast-like giant cells. Solid pseudopapillary tumor is a rare low-grade neoplasm that mainly affects younger women, and generally has a very good prognosis.[2][25]

Pancreatic mucinous cystic neoplasms are a broad group of pancreas tumors that have varying malignant potential. They are being detected at a greatly increased rate as CT scans become more powerful and common, and discussion continues as how best to assess and treat them, given that many are benign.[26]

Neuroendocrine

The small minority of tumors that arise elsewhere in the pancreas are mainly pancreatic neuroendocrine tumors (PanNETs).[27] Neuroendocrine tumors (NETs) are a diverse group of benign or malignant tumors that arise from the body's neuroendocrine cells, which are responsible for integrating the nervous and endocrine systems. NETs can start in most organs of the body, including the pancreas, where the various malignant types are all considered to be rare. PanNETs are grouped into 'functioning' and 'non-functioning' types, depending on the degree to which they produce hormones. The functioning types secrete hormones such as insulin, gastrin, and glucagon into the bloodstream, often in large quantities, giving rise to serious symptoms such as low blood sugar, but also favoring relatively early detection. The most common functioning PanNETs are insulinomas and gastrinomas, named after the hormones they secrete. The non-functioning types do not secrete hormones in a sufficient quantity to give rise to overt clinical symptoms. For this reason, non-functioning PanNETs are often diagnosed only after the cancer has spread to other parts of the body.[28]

As with other neuroendocrine tumors, the history of the terminology and classification of PanNETs is complex.[27] PanNETs are sometimes called "islet cell cancers",[29] even though it is now known that they do not actually arise from islet cells as previously thought.[28]

Other Languages
bosanski: Rak gušterače
ދިވެހިބަސް: ޗިސްމޭގެ ކެންސަރު
한국어: 췌장암
hrvatski: Rak gušterače
Bahasa Indonesia: Kanker pankreas
lietuvių: Kasos vėžys
македонски: Рак на панкреасот
Bahasa Melayu: Kanser pankreas
Nederlands: Alvleesklierkanker
日本語: 膵癌
polski: Rak trzustki
Simple English: Pancreatic cancer
slovenčina: Rakovina pankreasu
slovenščina: Rak trebušne slinavke
српски / srpski: Рак гуштераче
srpskohrvatski / српскохрватски: Rak gušterače
Tiếng Việt: Ung thư tuyến tụy
中文: 胰腺癌