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Pancreatic Cancer: Overview and Risk Factors

Pancreatic cancer is the fourth most common cancer and the fifth most common cause of cancer–related mortality. Little is known about etiologic agents, but tobacco use is probably the most important modifiable risk factor.

More than 90% of pancreatic cancers are adenocarcinomas, which will be discussed here. Less common pancreatic tumors include endocrine tumors, carcinoid tumors, and lymphoma.

The characteristic presentation includes an insidious onset of weight loss, fatigue, anorexia, and gnawing abdominal or back pain. The most common symptom is epigastric pain with radiation to the back, which often improves upon bending forward. In addition, painless jaundice, dark urine, acholic stools, pruritis, migratory thrombophlebitis, or Courvoisier’s sign (a palpable, nontender gallbladder) may be present.

Unfortunately, by the time symptoms appear, the cancer has generally become quite advanced. At the time of diagnosis, more than 80% of patients have advanced tumors marked by either local extension into adjacent organs (such as the liver) or solitary or multiple distant metastases, resulting in a very poor long–term survival rate. Most patients die within a year of diagnosis.

Risk Factors

Males and African Americans have a slightly higher risk. Additional factors associated with risk include the following:

Smoking.

Age. The condition is rare before 45 years old. Incidence increases with age.

Family history. About 5% to 10% of patients with pancreatic cancer have a first–degree relative with the disease.

Genetics. Mutations in the p16, K–ras, CDKN2A, p53, and BRCA genes appear to increase the risk.

Obesity.

Asbestos exposure.

Dietary factors (see Nutritional Considerations).

 

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Pancreatic Cancer: Diagnosis and Treatment >>