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  • Pancreatic cancer has a five-year survival of 10%, and it is expected to become the second leading cause of cancer death in the United States by 2030.

  • Modifiable risk factors for pancreatic cancer include tobacco use, obesity, diabetes mellitus (particularly new-onset diabetes), and chronic pancreatitis. Age and family history are well-established, nonmodifiable risk factors.

  • KRAS mutations and p16 inactivation are near universal genomic events identified in pancreatic cancers, and histologically, pancreatic adenocarcinomas are characterized by a dense, collagenous stroma.

  • High-quality multidetector computed tomography imaging is the gold-standard diagnostic and staging modality, because it can classify pancreatic cancers as resectable, borderline resectable, locally advanced, or metastatic.

  • The only potentially curative treatment for pancreatic cancer is surgical resection, which is an option for only 15% to 20% of patients, because most patients are diagnosed at an advanced stage.

  • Recent advances in combination chemotherapy, particularly FOLFIRINOX and gemcitabine plus nab-paclitaxel, have increased survival for patients with advanced pancreatic cancer; FOLFIRINOX also improves survival in the adjuvant setting.

  • Precision medicine is slowly emerging in pancreatic cancer


When clinicians use the term pancreatic cancer, they refer to adenocarcinoma of the pancreas, one of the most challenging malignancies facing oncologists, patients, and caregivers today. This disease is characterized by significant morbidity and a poor prognosis. At the MDACC, we manage pancreatic cancer using a multidisciplinary approach. For patients with localized disease, we generally employ a stepwise multimodality approach. For most patients with locally advanced disease and all patients with metastatic disease, palliation is a high priority. This chapter summarizes our current knowledge about pancreatic cancer, including its epidemiology, risk factors, molecular biology, diagnosis and staging, and clinical strategies for therapy.


Pancreatic adenocarcinoma, the most common pancreatic neoplasm, is an aggressive and often rapidly fatal malignancy. In the United States, it represents 3% of all cancer cases but accounts for 7.5% of all cancer deaths.1 As of this writing, it is the third leading cause of cancer-related deaths, ranking behind lung and colorectal cancers. The 5-year survival rate has marginally improved over the past few decades (2% in 1974–1976, 6% in 2014) and has recently reached 10% for the first time.2,3 Over the next decade, deaths caused by pancreatic cancer are projected to increase dramatically, overtaking colorectal cancer as the second leading cause of cancer-related death.


There are approximately 56,000 new cases of pancreatic cancer each year in the United States and 459,000 cases worldwide.4 Incidence rates are highest in industrialized societies and Western countries. Of note, the risk of pancreatic cancer among Blacks, in whom pancreatic cancer mortality rates are higher than most other ethnic groups in the United States, is considerably higher than the rates for African Blacks.5 The risk of developing pancreatic cancer is low in the first three to four ...

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