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INTRODUCTION

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Epidemiology

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Epidemiology
Incidence: 46,420 (male: 23,530; female: 22,890. Estimated new cases for 2014 in the United States) Stage at presentation:
(13.9 per 100,000 males; 10.9 per 100,000 females) Stage I: 20%
Deaths: Estimated 39,590 in 2014 (male: 20,170; female: 19,420) Stage II: 40%
Median age: 71 years Stage III–IV: 40%
Male to female ratio: ~1:1

Siegel R et al. CA Cancer J Clin 2014;64:9–29

Surveillance, Epidemiology, and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2013)

Takhar AS et al. BMJ 2004;329:668–673

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Pathology

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Pathology

Most cancers of the pancreas arise in the head of the pancreas (60–70%), 15% in the body, and 5% in the tail; in 20%, the neoplasm diffusely involves the entire gland

Malignant Tumors of Pancreatic Origin
Ductal adenocarcinoma 85–90%
Acinar cell carcinoma 1–2%
Undifferentiated carcinoma (anaplastic giant cell, osteoclastic giant cell) <1%
Sarcomatoid carcinoma/carcinosarcoma <1%

de Braud F et al. Crit Rev Oncol Hematol 2004;50: 147–155

Solcia E et al. Tumors of the pancreas. In: Atlas of Tumor Pathology, 3rd series. Washington, DC: Armed Forces Institute; 1997

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Work-up

The diagnosis of pancreatic cancer is based on imaging studies and histologic confirmation performed by fine-needle aspiration by endoscopic ultrasonography (EUS), biopsy under CT or US guidance, or during laparotomy

  • History and physical examination

  • CBC and differential, serum electrolytes, creatinine, LFTs, PT, PTT, CA19-9

  • Imaging:

    • Spiral CT: Spiral or a helical CT of the abdomen according to a defined pancreatic protocol is essential. CT provides localization, size of the primary tumor, and evidence of metastasis and evaluates major vessels adjacent to the pancreas for neoplastic invasion or thrombosis. CT is almost 100% accurate in predicting unresectable disease. However, the positive predictive value of the test is low and approximately 25–50% of patients predicted to have resectable disease on CT turn out to have unresectable lesions at laparotomy

    • Endoscopic retrograde cholangiopancreatography (ERCP) can also be useful in patients whom a CT scan is equivocal, because fewer than 3% of patients with pancreatic carcinoma have normal pancreatograms

    • EUS is a relatively new technique and provides useful information. However, EUS needs to be performed in centers with experience in this procedure. EUS is useful for characterizing cystic lesions and assessment of vascular invasion by tumor. In addition, an aspirate can be done for histologic diagnosis. A celiac plexus block can be done via EUS for relief of abdominal pain

 

Agawam B. Am J Gastroenterol 2004;99:844–850

Tamm EP et al. Radiographic Imaging: Daniel D. Von Hoff, Douglas B. Evans, Ralph H. Hruban, eds. Pancreatic Cancer, 1st ed. Jones & Bartlett Publishers, 2005:165–180

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Staging

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Staging
Primary Tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor limited to the pancreas, 2 cm or ...

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