Pancreatic Cancer

Pancreatic cancer is a malignant neoplasm arising from the exocrine or, less commonly, endocrine pancreas, characterized by aggressive local invasion, early metastasis, and poor prognosis.

Definition

Pancreatic cancer is a malignant neoplasm arising from the exocrine or, less commonly, endocrine pancreas, characterized by aggressive local invasion, early metastasis, and poor prognosis.

Epidemiology

7th–12th most common cancer worldwide depending on region
Median age at diagnosis: 65–70 years
Slight male predominance
High mortality due to late diagnosis and aggressive nature
Risk factors: smoking, chronic pancreatitis, diabetes, obesity, family history, genetic syndromes (BRCA, Lynch)

Etiology

Genetic mutations: KRAS (>90%), TP53, CDKN2A, SMAD4
Chronic pancreatitis and pancreatic cystic neoplasms
Environmental: tobacco smoking, heavy alcohol use, obesity
Family history of pancreatic cancer or hereditary cancer syndromes
New-onset diabetes in older adults may be an early indicator

Pathophysiology

Malignant transformation of pancreatic ductal epithelial cells (most common: pancreatic ductal adenocarcinoma)
Invasion into peripancreatic tissue, blood vessels, and lymph nodes
Desmoplastic stromal reaction limiting drug penetration
Metastasis primarily to liver, peritoneum, lungs, and regional lymph nodes
Endocrine dysfunction may occur in pancreatic islet involvement
Tumor-associated inflammation and fibrosis contribute to local complications