Pancreatic Cancer: An Overview of Introduction, Types, Pathogenesis, Lab Diagnosis, Treatment, Prevention, and Keynotes

Introduction

Pancreatic cancer is a highly aggressive malignancy arising from the exocrine or endocrine pancreas, most commonly from the pancreatic ductal epithelium. It is associated with a poor prognosis due to late presentation and early metastasis.

Types of Pancreatic Cancer

• Pancreatic ductal adenocarcinoma (PDAC) – most common
• Neuroendocrine tumors (PanNETs)
• Acinar cell carcinoma
• Solid pseudopapillary tumor
• Pancreatoblastoma (rare)

Pathogenesis

• Progression from pancreatic intraepithelial neoplasia (PanIN)
• Genetic mutations: KRAS (early event), TP53, CDKN2A, SMAD4
• Chronic inflammation (chronic pancreatitis)
• Risk factors: smoking, diabetes mellitus, obesity, hereditary syndromes
• Tumor desmoplasia and early invasion

Laboratory Diagnosis

• Imaging: Contrast-enhanced CT scan (gold standard), MRI
• Endoscopic ultrasound (EUS) with fine-needle aspiration
• Histopathology for definitive diagnosis
• Tumor markers: CA 19-9 (monitoring)
• Molecular testing in selected cases

Treatment

• Surgical resection (Whipple procedure) in resectable disease
• Chemotherapy (gemcitabine-based, FOLFIRINOX)
• Radiotherapy (selected cases)
• Targeted therapy and immunotherapy (limited benefit)
• Palliative and supportive care

Prevention

• Smoking cessation
• Control of diabetes and chronic pancreatitis
• Healthy diet and weight management
• Genetic counseling for high-risk families
• Early evaluation of suspicious symptoms

Keynotes

• PDAC is the most common pancreatic cancer.
• KRAS mutation is a hallmark feature.
• CA 19-9 is useful for monitoring, not screening.
• Surgery offers the only potential cure.
• Prognosis remains poor due to late diagnosis.

Further Readings

1. https://www.mdpi.com/2673-7523/5/3/37
2. https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq
3. https://www.ncbi.nlm.nih.gov/books/NBK606510
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC11965705
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC2094388
6. https://www.canceraustralia.gov.au/cancer-types/pancreatic_cancer/types-pancreatic_cancer
7. https://www.cityofhope.org/clinical-program/pancreatic_cancer/types
8. https://www.ncbi.nlm.nih.gov/books/NBK518996
9. https://www.indonesianjournalofclinicalpathology.org/index.php/patologi/article/download/1891/pdf/5455
10. https://www.mayoclinic.org/diseases-conditions/pancreatic_cancer/diagnosis-treatment/drc-20355427
11. https://my.clevelandclinic.org/health/diagnostics/22607-cancer-stages-grades-system