Epidemiology

Pancreatic cancer is a silent killer, being the fourth most fatal cancer
in both males and females in Europe and the US 1. The projected
mortality in 2016 for pancreatic cancer is estimated as high as 42600
and 43000 for males and females in the EU, respectively, with an
incidence of 7.88 and 5.60 per 100000 person-years for each sex 2. In
the US, during 2016, an estimated 53070 people will be diagnosed and
41780 will die due to pancreatic cancer3. Mean age of appearance is 71
for men and 75 for women. The 5-year survival rate after resection is
approximately 20%, which is feasible at 15-20% of patients presenting
at centres of excellence1.

Etiology

It is well known that pancreatic cancer appears sporadically at 80-90%

of affected patients, while there are more and less well studied causes
of familial mutation pancreatic cancer1,4. A well-established relationship
has been documented between cigarette smoking and pancreatic
cancer, with an odds ratio of 2.2 for current smokers and 1.2 for former
ones in a recent analysis of the PanC4 Consortium 5. Moreover, obesity,
inactivity and a Western type diet are all associated with increased risk
of pancreatic cancer. Chronic pancreatitis is also a known risk factor,
with its leading cause, excessive alcohol consumption, being also
linked to higher prevalence of pancreatic cancer in comparison with
the general population. As far as familial cancer is concerned, the
definition of which is a history of pancreatic cancer in at least two firstdegree family members, BRCA2 mutation is the most common cause.
Others include Peutz-Jeughers, Li-Fraumeni and Lynch Syndromes, as
well as, Familial Atypical Malignant Mole Melanoma.

Clinicopathological correlations

Pancreatic cancer is predominantly derived from the exocrine

pancreas, at around 95% of cases, while the rest 5% come from
endocrine cells. Approximately 95% of exocrine tumours are
adenocarcinomas and the rest are cystic tumours. Pancreatic
adenocarcinoma most commonly involves the head or the uncinate
process of the pancreas (60-70%), but can also be located in the body
or tail of the organ, or even in a 10-15% . Tumours of the body and tail
are usually more aggressive and diagnosed at later stage of disease
due to lack of symptoms. Patients usually are asymptomatic, while
obstructive jaundice, abdominal pain, weight loss, duodenal
obstruction, steatorrhea and new onset diabetes are symptoms that
patients could present with. Diagnosis is established with multiple
detector computed tomography (MDCT) with intravenous contrast
agent, scanning at an arterial pancreatic phase (40-50 sec) and a
venous phase (60-70 sec) after infusion. Magnetic resonance imaging

(MRI) is an alternative solution, with equal results, but better imaging

of uncharacterised liver lesions.
EUS

Principles of surgical therapy

Resectability, Procedures, R0 resection & vascular resection (venous

arterial)

Principles of systemic therapy

Genomics Personalised Medicine