BACKGROUND AND INTRODUCTION
Pancreatic cancer is a devastating disease that presents late and is fatal in nearly all cases. It affects about 12 per 100,000 men and women in the United States per year. This means that approximately 1.5% of U.S. men and women will be diagnosed with pancreatic cancer at some point during their lifetime. Although relatively rare compared to other cancers, comprising only 3.1% of all new cancer cases, it is the fourth leading cause of cancer death. In 2016 it was estimated that there were 53,070 new cases of pancreatic cancer and 49,620 people living with pancreatic cancer in the United States. According to Surveillance, Epidemiology, and End Results (SEER) data, new pancreas cancer cases have been rising on average 1.2% each year over the last 10 years and death rates have been rising on average 0.4% each year over the same period.1
Pancreatic cancer tends to affect older individuals with a median age at diagnosis of 70 and a median age of death of 73 years. Although nearly equally prevalent in both sexes, there is a 30% higher predilection for pancreatic cancer in men over women. Pancreatic cancer appears to be more prevalent in the black population over whites, Hispanics, and Asians. Despite substantial international variation, within the United States, pancreatic cancer incidence and mortality rates vary only slightly between states. The pancreatic cancer death rate is highest in the northeast, with Connecticut having the third highest death rate after Washington, DC and Louisiana.2
Despite the low incidence and prevalence, pancreatic cancer is deadly, causing 6.6% of all cancer deaths. Based on most recent available data, the 5-year OS is 8%. The overwhelming majority of pancreatic cancer patients present with advanced disease at diagnosis, with over 90% having spread outside of the primary pancreatic tumor. Once spread, even to regional lymph nodes, 5-year survival drops precipitously from 24.1% in patients with localized disease to 2% in those with distant disease. When compared to other cancers, the survival rate for the disease has not substantially improved. Since 1975, the 5-year relative survival rate for pancreatic cancer has improved from 2% to 8%, whereas in the same time frame the overall 5-year relative survival rate for all cancer sites has improved from 49% to 68% and some cancer survival rates are 90% or above.2
Unfortunately, the initial symptoms of pancreatic cancer are often nonspecific and subtle and thus are easily attributed to other processes. Early-stage pancreatic cancer is often asymptomatic. Symptoms may widely vary based on the location of the tumor. When symptoms do occur, they are maybe caused by mass effect rather than disruption of exocrine or endocrine function. The most common metastatic sites are the liver, lung, and peritoneum. Symptoms associated with localized or metastatic pancreatic cancer may include back and abdominal pain, anorexia, early satiety, new-onset diabetes mellitus, sleep problems, depression, and weight loss. However, ...