Skip to Main Content

INTRODUCTION

Epidemiology

| Download (.pdf) | Print
Epidemiology
Incidence

  • 3.2% of all new cancer cases

  • Estimated new cases for 2019 in the United States: 56,770 (male: 29,940; female: 26,830)

  • 12.6 per 100,000 men and women

Deaths Estimated 57,600 in 2020 (male: 30,400; female: 27,200)
Median age 70 years
Male to female ratio ~1:1
 
Stage at presentation Stage I: 10%
  Stage II: 22%
  Stage III: 13%
  Stage IV: 55%
 
Location at Presentation and Surgical Resection
Location Percent of all presentations Percent amenable to surgical resection at each disease site
Head of pancreas 67% 27.9%
Pancreas body 16% 10.7%
Tail of pancreas 17% 17%
 
Surgical resection Overall 25% of patients undergo surgery
Survival

5-year survival, all patients = 9.3%

5-year survival following resection = 25%

Bilimoria et al. Cancer 2007;110:1227–1234

Huang L et al. Gut 2019;68:130–139

Siegel RL et al. CA Cancer J Clin 2019;69:7–34

Surveillance, Epidemiology, and End Results (SEER) Program, available from http://seer.cancer.gov [accessed in 2019]

Winer LK et al. J Surg Res 2019;239:60–66

Pathology

| Download (.pdf) | Print
Pathology
Malignant tumors of the pancreatic origin
Histology Percent
Ductal adenocarcinoma 85–90%
Adenosquamous carcinoma 1–4%
Colloid carcinoma (mucinous noncystic carcinoma) 1–3%
Acinar cell carcinoma 1–2%
Undifferentiated carcinoma without or with osteoclast-like giant cells <1%
Mixed acinar-ductal carcinoma; mixed acinar-neuroendocrine carcinoma; mixed acinar-neuroendocrine-ductal carcinoma; pancreatoblastoma <1%
Sarcoma <1%
Small cell carcinoma <1%
Squamous cell carcinoma <1%
Other (hepatoid carcinoma; medullary carcinoma; signet ring cell carcinoma; acinar cell cystadenocarcinoma; intraductal papillary mucinous neoplasm with an associated invasive carcinoma; mucinous cystic neoplasm with an associated invasive carcinoma; serous cystadenocarcinoma; solid-pseudopapillary carcinoma) <1%
Adapted from the WHO classification of tumors

Work-up

General and tumor markers

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. In some clinical situations, relying on fine needle aspiration alone is not recommended.

  • History and physical examination

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

  • Measure CA19–9, CEA, and CA125 at baseline. While CA19–9 is often elevated in pancreatic cancer, the other serum tumor markers should be measured at baseline, as 8% of patients carry genetic variants in the Fucosyltransferase 3 gene, which results in a negative test for CA19–9 (the Lewis antigen). In PDAC, CEA or CA125 have a sensitivity of 63.8 and 51.1%, respectively. These markers may be valuable if elevated

 

Luo G et al. Ann Surg 2017;265:800–805

Vestergaard EM et al. Clin Chem 1999;45:54–61

 

Imaging

  • Spiral CT: spiral or helical CT of the abdomen according to a defined triple-phase pancreas 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 ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.