Pancreatic cancer natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2] Sudarshana Datta, MD [3]
Overview
Patients with pancreatic cancer present with symptoms such as jaundice, light-colored stools, dark urine, and epigastric pain in the sixth decade of life. If left untreated, patients with pancreatic cancer may progress to develop exocrine pancreatic insufficiency arising from pancreatic duct obstruction leading to malabsorption, malnutrition and cachexia. Common complications of pancreatic cancer include intractable pain and obstructive jaundice that develop as a result of surgical intervention. Depending on the extent of the tumor at the time of diagnosis, the prognosis is generally regarded as poor, with complete remission being extremely rare.
Natural History
The natural history of pancreatic cancer is as follows:[1][2][3]
- The symptoms of pancreatic cancer usually develop in the sixth decade of life, and start with symptoms such as jaundice, light-colored stools, dark urine, pain in the upper or middle abdomen and back, unexplained weight loss, anorexia and fatigue.
- The symptoms of pancreatic cancer typically develop about 20-30 years after exposure to risk factors such as smoking and alcohol. Genetic factors such as alterations in tumor suppressor genes, oncogenes and different signaling pathways may also be responsible.
- If left untreated, patients with pancreatic cancer may progress to develop exocrine pancreatic insufficiency arising from pancreatic duct obstruction leading to malabsorption, malnutrition and cachexia. Dudodenal obstruction and biliary obstruction may cause symptoms of bowel obstruction and jaundice. Metastasis may occur to different sites.
Complications
Common complications of pancreatic cancer may arise as a result of the disease or therapy:[4][5][6][7][8][9][10]
- Malabsorption
- Exocrine pancreatic insufficiency due to pancreatic duct obstruction by the tumor may lead to malabsorption. Malabsorption in patients presents with anorexia, weight loss, and diarrhea.
- Intractable pain
- Patients with advanced pancreatic cancer may develop intractable pain requiring narcotic analgesics and surgical intervention such as neurolysis of celiac ganglia.[4][11]
- Jaundice
- Obstructive jaundice can present with features of cholangitis:
- Fever and chills
- Nausea, vomiting
- Clay-colored stools
- Dark urine
- Yellowish discoloration of skin
- Pruritus
- Right upper quadrant pain
- Anorexia
- Obstructive jaundice can present with features of cholangitis:
- Patients may require Endoscopic decompression with stent placement in patients due to biliary obstruction.
- Duodenal obstruction
- Patients may develop duodenal obstruction as a result of complications of surgery.
- Duodenal obstruction may be treated with endoscopic stenting or gastrojejunostomy.
Prognosis
- The primary factors that influence prognosis are:
- Whether the tumor is localized and can be completely resected
- Whether the tumor has spread to lymph nodes or elsewhere
Staging and TNM (tumour, lymph node, metastasis) classification related to incidence, treatment, and prognosis:[12]
| Staging and TNM Classification related to Incidence, Treatment, and Prognosis | ||||
|---|---|---|---|---|
| Stage | TNM Classification | Clinical Classification | Incidence at diagnosis (%) | 5-year survival rate (%) |
| 0 | Tis, N0, M0 | Resectable | 7.5 | 15 |
| IA | T1, N0, M0 | — | — | 14 |
| IB | T2, N0, M0 | — | — | 12 |
| IIA | T3, N0, M0 | — | — | 7 |
| IIB | T1-3, N1, M0 | Locally advanced | 29.3 | 5 |
| III | T4, any N, M0 | — | — | 3 |
| IV | Any T, any N, M1 | Metastatic | 47.2 | 1 |
Five year survival rate
- The percentage of people who live for a minimum of five years after diagnosis is called the 5- year survival rate.
- Survival rates for exocrine pancreatic cancer:
- Lifespan is found to be longer in patients treated with surgery, as opposed to other patients.
- The 5-year survival rate for people at various stages of pancreatic cancer are as follows based on the most recent statistics of the American Cancer Society are as follows:[13][14]
- Stage IA: 14%
- Stage IB: 12%
- Stage IIA 7%
- Stage IIB 5%
- Stage III 3%
- Stage IV 1%
- Survival rates for neuroendocrine pancreatic tumors (treated with surgery) are as follows:
- Stage I pancreatic NETs 61%
- Stage II pancreatic NETs 52%
- Stage III pancreatic NETs 41%
- Stage IV pancreatic NETs 16%
- Five year survival rate of tumors not removed by surgery is 16%
References
- ↑ Chang SC, Yang WV (2016). "Hyperglycemia, tumorigenesis, and chronic inflammation". Crit. Rev. Oncol. Hematol. 108: 146–153. doi:10.1016/j.critrevonc.2016.11.003. PMID 27931833.
- ↑ Sohal DP, Mangu PB, Khorana AA, Shah MA, Philip PA, O'Reilly EM, Uronis HE, Ramanathan RK, Crane CH, Engebretson A, Ruggiero JT, Copur MS, Lau M, Urba S, Laheru D (2016). "Metastatic Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline". J. Clin. Oncol. 34 (23): 2784–96. doi:10.1200/JCO.2016.67.1412. PMC 5019760. PMID 27247222.
- ↑ Frič P, Škrha J, Šedo A, Bušek P, Kmochová K, Laclav M, Solař S, Bunganič B, Zavoral M (2016). "Early pancreatic carcinogenesis - risk factors, early symptoms, and the impact of antidiabetic drugs". Eur J Gastroenterol Hepatol. 28 (7): e19–25. doi:10.1097/MEG.0000000000000646. PMID 27120389.
- ↑ 4.0 4.1 Koulouris AI, Banim P, Hart AR (2017). "Pain in Patients with Pancreatic Cancer: Prevalence, Mechanisms, Management and Future Developments". Dig. Dis. Sci. 62 (4): 861–870. doi:10.1007/s10620-017-4488-z. PMID 28229252.
- ↑ Ramsey ML, Conwell DL, Hart PA (2017). "Complications of Chronic Pancreatitis". Dig. Dis. Sci. 62 (7): 1745–1750. doi:10.1007/s10620-017-4518-x. PMC 5667546. PMID 28281169.
- ↑ Vujasinovic M, Valente R, Del Chiaro M, Permert J, Löhr JM (2017). "Pancreatic Exocrine Insufficiency in Pancreatic Cancer". Nutrients. 9 (3). doi:10.3390/nu9030183. PMC 5372846. PMID 28241470.
- ↑ Poruk KE, Wolfgang CL (2016). "Palliative Management of Unresectable Pancreas Cancer". Surg. Oncol. Clin. N. Am. 25 (2): 327–37. doi:10.1016/j.soc.2015.11.005. PMID 27013367.
- ↑ Kapoor VK (2016). "Complications of pancreato-duodenectomy". Rozhl Chir. 95 (2): 53–9. PMID 27008166.
- ↑ Hucl T (2016). "[Malignant biliary obstruction]". Cas. Lek. Cesk. (in Czech). 155 (1): 30–7. PMID 26898789.
- ↑ Dong J, Cong L, Zhang TP, Zhao YP (2016). "Pancreatic metastasis of renal cell carcinoma". HBPD INT. 15 (1): 30–8. PMID 26818541.
- ↑ Dobosz Ł, Kaczor M, Stefaniak TJ (2016). "Pain in pancreatic cancer: review of medical and surgical remedies". ANZ J Surg. 86 (10): 756–761. doi:10.1111/ans.13609. PMID 27111447.
- ↑ Bond-Smith G, Banga N, Hammond TM, Imber CJ (2012). "Pancreatic adenocarcinoma". BMJ. 344: e2476. doi:10.1136/bmj.e2476. PMID 22592847.
- ↑ "Pancreatic Cancer Survival Rates, by Stage".
- ↑ Carrato, A.; Falcone, A.; Ducreux, M.; Valle, J. W.; Parnaby, A.; Djazouli, K.; Alnwick-Allu, K.; Hutchings, A.; Palaska, C.; Parthenaki, I. (2015). "A Systematic Review of the Burden of Pancreatic Cancer in Europe: Real-World Impact on Survival, Quality of Life and Costs". Journal of Gastrointestinal Cancer. 46 (3): 201–211. doi:10.1007/s12029-015-9724-1. ISSN 1941-6628.