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