PANCREATIC CANCER

In 2019 in the United States, about 56,770 new cases and 45,750 deaths. The incidence is decreasing somewhat, but nearly all diagnosed cases are fatal. The tumors are ductal adenocarcinomas and are not usually detected until the disease has spread. About 70% of tumors are in the pancreatic head, 20% in the body, and 10% in the tail. Mutations in K-ras have been found in 85% of tumors, and the p16 cyclin-dependent kinase inhibitor on chromosome 9 may also be implicated. Long-standing diabetes, chronic pancreatitis, and smoking increase the risk; coffee-drinking, alcoholism, and cholelithiasis do not. Pts present with pain and weight loss, the pain often relieved by bending forward. Jaundice commonly complicates tumors of the head, due to biliary obstruction. CA-19-9 can serve as a tumor marker in serum in some pts. Curative surgical resections are feasible in about 10%. Adjuvant chemotherapy (5FU) may benefit some pts after resection. Gemcitabine plus erlotinib or capecitabine may palliate symptoms in pts with advanced disease. Fit pts may obtain some benefit from the combination regimen, FOLFIRINOX, that includes 5FU, irinotecan, and oxaliplatin. FOLFIRINOX prolongs disease-free survival after complete resection.

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